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Paul H. Brookes Publishing Co.
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Baltimore, Maryland 21285-0624
USA

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Copyright © 2017 by Paul H. Brookes Publishing Co., Inc.

All rights reserved.
Previous edition copyright © 2000

“Paul H. Brookes Publishing Co.” is a registered trademark of

Paul H. Brookes Publishing Co., Inc.

All examples in this book are composites. Any similarity to actual individuals or circumstances is coincidental, and no implications should be
inferred.

Purchasers of DO-WATCH-LISTEN-SAY: Social and Communication Intervention for Autism Spectrum Disorder, Second Edition are granted
permission to download, print, and photocopy the assessment tool, any blank forms appearing in the appendixes, and the activity sheets. Please
visit brookespublishing.com/downloads with (case sensitive) keycode: 78ilKaT02. These forms may not be reproduced to generate revenue for
any program or individual. Photocopies may only be made from an original book. Unauthorized use beyond this privilege may be prosecutable under
federal law. You will see the copyright protection notice at the bottom of each photocopiable page.

Library of Congress Cataloging-in-Publication Data

Names: Quill, Kathleen Ann, 1952- author. | Stansberry Brusnahan, L. Lynn., author.
Title: Do-watch-listen-say : social and communication intervention for autism spectrum disorder / by Kathleen Ann Quill, Ed.D., BCBA-D,
The Autism Institute, Essex, Massachusetts and L. Lynn Stansberry Brusnahan, Ph.D., University of St. Thomas, Minneapolis,
Minnesota.
Other titles: Do watch listen say
Description: Second edition. | Baltimore : Paul H. Brookes Publishing Co., [2017] | Includes bibliographical references and index. Identifiers:
LCCN 2016050144| ISBN 9781598579802 (pbk.) | ISBN 9781681252322 (epub) | ISBN 9781681252339 (pdf)
Subjects: LCSH: Autistic children—Rehabilitation. | Autistic children—Education.
Classification: LCC RJ506.A9 Q55 2017 | DDC 618.92/85882—dc23
LC record available at https://lccn.loc.gov/2016050144

British Library Cataloguing in Publication data are available from the British Library.

Version 1.0

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Contents

About the Online Materials

About the Authors
The DO-WATCH-LISTEN-SAY Approach to Assessment and Intervention
The Emotional Needs of the Child
1. Understanding the Complexity of Autism
Historical Overview and Contemporary Implications of Autism
Identifying and Diagnosing Autism
Cognition in Autism
Summary
2. Understanding Social and Communication Development and Challenges
Core Skills for Social and Communication Development
Social Skill Development
Communication Skill Development
Restricted, Repetitive Behavior in Autism
Summary
3. Assessing Social and Communication Skills
Understanding Educational Assessments
Assessment of Social and Communication Skills in Autism
The Assessment of Social and Communication Skills for Individuals with Autism Spectrum Disorder,
Revised (ASCS-2)
Summary
Appendix: Assessment of Social and Communication Skills for Individuals with Autism Spectrum
Disorder, Revised (ASCS-2)
4. Designing Intervention
Intervention Planning: An Overview
Framework for Targeting Skills
Framework for Intervention: Core Skills
Framework for Intervention: Social Skills
Framework for Intervention: Communication Skills
Framework for Intervention: Community Skills
Framework for Intervention: Restricted and Repetitive Behaviors
Summary
5. Selecting Evidence-Based Practices to Enhance Social and Communication Skills
Evidence-Based Intervention Practices
Intervention Approaches

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 Summary
6. Instructional Strategies to Enhance Social and Communication Skills
Teaching Opportunities
Explicit Instruction and Interactions
Summary
7. Instructional Supports to Enhance Social and Communication Skills
Organizational Supports
Social Supports
Communication Supports
Behavioral Supports
Summary
8. Activities to Promote Skill Development
Activity Strategies
Using the Sample Activity Sheets
Core Skills Activity Sheets
Social Skills Activity Sheets
Communication Skills Activity Sheets
9. Collecting Data to Measure Authentic Progress
Overview of Progress Monitoring
Monitoring Skill Emergence, Mastery, and Generalization
Data Collection Forms
Using Data to Make Intervention Decisions
Summary
Appendix A: Progress Monitoring Forms—Quantitative Data Collection Forms
Appendix B: Progress Monitoring Forms—Qualitative Data Collection Forms

References
Index

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About the Online Materials

THE FORMS, ASSESSMENT TOOL, AND ACTIVITY SHEETS:

Purchasers of this book may download, print, and/or photocopy the assessment tool, any blank forms
appearing in the appendixes, and activity sheets for professional and educational use. These materials are
included with the print book and e-book and are also available at brookespublishing.com/downloads with
(case sensitive) keycode: 78ilKaT02.

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About the Authors

Kathleen Ann Quill, Ed.D., BCBA-D, The Autism Institute, Essex, Massachusetts
Kathleen Ann Quill, Ed.D., BCBA-D, is a compassionate professional who has spent 40 years supporting
individuals with autism spectrum disorder. She is a developmental psycholinguist, educator, and board
certified behavior analyst (BCBA-D). Dr. Quill has conducted trainings in more than 20 countries, given the
keynote address for 10 international organizations, and presented at more than 200 conferences. She discusses
how to integrate behavioral (applied behavior analysis) and developmental treatment models to enhance
language, communication, and social learning. Dr. Quill promotes innovative solutions that bridge the gap
between research and practice in order to sustain quality education for all students with autism.
Prior to founding the Autism Institute, Dr. Quill was a professor at the University of Massachusetts and
Lesley University in Boston and conducted applied research on developmental differences in autism. She is
the author of two seminal texts, numerous publications, and online resources on the topic. She is also on the
editorial board for Journal of Autism and Developmental Disorders and Focus on Autism and Other Developmental
Disabilities. She facilitates Professional Learning Communities through regional and national partnerships
and collaborates with companies to design technology solutions for educators.

L. Lynn Stansberry Brusnahan, Ph.D., Associate Professor, Teacher Education, University of St. Thomas,
Minneapolis, Minnesota
Laroye “Lynn” Stansberry Brusnahan, Ph.D., is the parent of an adult with autism and an associate professor
in teacher education at the University of St. Thomas in Minnesota. She coordinates the autism spectrum
disorder certificate, license, and master’s program. She was the 2012 Autism Society of America Professional
of the Year. Dr. Stansberry Brusnahan has a doctorate from the University of Wisconsin-Milwaukee in
Exceptional Education. She has served on numerous boards including the Autism Society of America
National Board, the Council for Exceptional Children’s Division on Autism and Development Disabilities
Board, and Minnesota Life College’s professional advisory board. She worked with the Minnesota
Department of Education, where she helped craft an autism spectrum disorder special education license for
educators. She has an active agenda as an invited speaker at the local, national, and international level.

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The DO-WATCH-LISTEN-SAY Approach to
Assessment and Intervention

Autism is a disorder of social, communicative, and repetitive behaviors. Because communication and social
development challenges are defining characteristics of autism, assessing and teaching social and
communication skills should be a priority for children on the spectrum. It can be a formidable task to build
these skills in children with autism, who frequently display behaviors that are perplexing and seem
inconsistent with what is understood about childhood development. It is generally assumed, particularly in
education, that all children follow a similar developmental path. Yet children with autism display patterns of
communication and social development that can follow a uniquely different path. These developmental
differences were considered in the design of this second edition of DO-WATCH-LISTEN-SAY.
Social activities are complex and dynamic, so intervention to teach social and communication skills should
be equally dynamic. This book’s approach is that assessment and intervention for social and communication
skills should help children with autism coordinate what to DO, who to WATCH, how to LISTEN, and
what to SAY in a variety of social situations. The purpose of this edition of DO-WATCH-LISTEN-SAY is to
provide assessment and intervention guidelines that specifically address building these critical skills and more.
It is an attempt to guide the thinking of educators, clinicians, and parents who are urgently working to bring
out the best in their students, clients, and children.

WHAT’S NEW IN THIS EDITION

The first edition of DO-WATCH-LISTEN-SAY was published 16 years ago. It continues to be sold
worldwide, translated into nine languages. The book was the first of its kind in the year 2000, offering
professionals and parents a means to understand, assess, and teach social and communication skills to children
of all developmental levels on the autism spectrum. After many requests for an updated edition, we are pleased
to share this second edition.
While our understanding of autism is always evolving, many of the fundamental principles and practices
that guided intervention 16 years ago continue to apply today. The major intervention shift has been twofold:
First, a stronger emphasis on data-based assessment and progress monitoring; and second, greater clarity
regarding which evidence-based practices benefit specific areas of social and communication development.
This second edition of DO-WATCH-LISTEN-SAY reflects these major intervention shifts. First, there are
many revisions to the comprehensive assessment tool included with this book, The Assessment of Social and
Communication Skills for Individuals with Autism Spectrum Disorder, Revised (ASCS-2). This assessment
evolved substantially from the Assessment of Social and Communication Skills for Children with Autism that
appeared in the 2000 edition. The ASCS-2 is now structured to allow for quantitative tracking of an
individual’s skill development over time. Additionally, a critical distinction is now made between skill mastery
and the child’s ability to demonstrate authentic skill generalization across persons and settings. It is our goal to
standardize the ASCS-2 in the next 2 years. There are also two complete chapters devoted to assessment and
progress monitoring, with printable data collection forms that the reader can duplicate. Second, this edition
contains a review of evidence-based practices for fostering social and communication development that is
linked to current research, as well as chapters on proven intervention strategies and intervention supports.

BOOK OVERVIEW

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The book is divided into nine chapters:
1. Understanding the Complexity of Autism: Chapter 1 introduces the complexity of autism spectrum
disorder. Readers will acquire a historical and contemporary overview of autism spectrum disorder; learn
how our understanding of autism has evolved; and become familiar with the social, communication, and
behavioral characteristics typically associated with autism.
2. Understanding Social and Communication Development and Challenges: In Chapter 2, readers will
learn about the typical development of core nonverbal social communication skills, social skills, and
communication skills and the associated developmental challenges in autism spectrum disorder. Readers
will also be introduced to the restricted and repetitive behaviors related to autism.
3. Assessing Social and Communication Skills: In Chapter 3, readers will learn a comprehensive assessment
process to identify social and communication challenges in children and youth with autism spectrum
disorder. The assessment tool introduced (ASCS-2) is designed to identify the presence of core
foundation skills, functional social and communication skills, and behavioral obstacles that interfere with
learning and development. The ASCS-2 is structured to track skill acquisition and functional skill use
separately.
4. Designing Intervention: In Chapter 4, readers will learn to design intervention plans utilizing systematic
frameworks to assess, target, and teach social and communication skills and address restricted and
repetitive patterns of behavior that interfere with learning and development. The DO-WATCH-
LISTEN-SAY framework is introduced, which provides general guidelines for teaching children with
autism what to DO, who to WATCH, how to LISTEN, and what to SAY in a variety of social
situations.
5. Selecting Evidence-Based Practices to Enhance Social and Communication Skills: In Chapter 5, readers
will learn how to select evidence-based practices to enhance social and communication skills.
6. Instructional Strategies to Enhance Social and Communication Skills: In Chapter 6, readers will learn
how to use instructional strategies to enhance social and communication skills and meet the needs of
children with autism.
7. Instructional Supports to Enhance Social and Communication Skills: In Chapter 7, readers will learn
how to use instructional and behavioral supports to enhance social and communication skills and meet the
needs of children with autism.
8. Activities to Promote Skill Development: In Chapter 8, readers will learn how to develop and implement
creative, motivating, and meaningful activities to meet an individual learner’s goals and objectives.
9. Collecting Data to Measure Authentic Progress: In Chapter 9, readers will learn how to collect ongoing
data to measure the acquisition and functional generalization of social and communication skills.
The first two chapters of this book discuss the developmental characteristics of autism. A thorough review
of the literature acquaints the reader with relevant findings on the complex relationship between cognitive,
social, and communication differences and repetitive and restricted behavior in autism. These foundational
chapters guide the reader to understand the complex developmental profiles of children with autism and
identify social and communication challenges. The behaviors and characteristics associated with autism are
made real and relevant through vignettes describing the perspectives and experiences of children on the
spectrum. Understanding and respect for the complexity of autism and the uniqueness of each child are
necessary to effectively use the assessment and treatment guidelines that follow.
Chapter 3 centers on social and communication skills assessment for children with autism and presents the
ASCS-2. This informal, criterion-referenced assessment is designed for both individuals who are verbal and
those who use an augmentative communication system and is used to create a comprehensive profile of a
child’s functional social and communication skills. The assessment is designed as a rating scale and checklist
that can be completed through interview, observation, or direct sampling. It was designed to assist in the
development of educational goals and objectives. The reader is provided with detailed guidelines for using the
assessment in Chapter 3, with the complete ASCS-2 provided in an Appendix and downloadable at
brookespublishing.com/downloads with (case sensitive) keycode: 78ilKaT02.
Chapters 4 and 5 review the current research on evidence-based practices and describe the continuum of
intervention options to build social and communication skills. The reader is given a framework for
systematically designing an intervention plan to be implemented across multiple settings. An eclectic approach
is described that interfaces best practices in contemporary behaviorism and developmental approaches.

10
Emphasis is given to the importance of systematically applying behavioral principles, while at the same time
building skills within the context of natural social experiences and developmentally age-appropriate
environments.
Chapters 6 and 7 explain how to use various evidence-based instructional strategies and supports to
enhance the acquisition and functional generalization of social and communication skills. The evidence-based
strategies are classified as traditional behavioral, developmental, and contemporary naturalistic strategies. The
evidence-based instructional supports are classified as organizational supports, social supports, communication
supports, and behavioral supports.
Chapter 8 presents sample activities to build the skills addressed in the ASCS-2. The collection of activity
sheets contains sample goals and behavioral objectives, functional activity ideas, and suggestions on how to
promote generalization of skills. The activity sheets in this chapter can be used with children and adolescents,
but the principles and practices apply to all individuals with autism.
Chapter 9 is devoted to progress monitoring and data collection. Through a series of case studies, the
reader is guided through the process of tracking the acquisition and generalization of social and
communication skills across home, school, and community settings. There are a number of data collection
forms that can be used for purposes of ongoing accountability and program review. Emphasis is placed on
means to measure authentic functional progress.

HOW TO USE THIS BOOK

This second edition of DO-WATCH-LISTEN-SAY offers the reader a thorough review of intervention for
children and youth with autism ages 3–18 years, with an emphasis on assessment and progress monitoring.
We encourage the reader to keep in mind that this and any other communication and social skills guide risk
minimizing the complexity and richness of these developmental areas. All social interactions require the ability
to simultaneously and flexibly understand what to DO, who to WATCH, how to LISTEN, and what to
SAY. The assessment tool (ASCS-2), guidelines to design intervention, and evidence-based teaching
practices are built upon the child’s struggle to integrate these four aspects of fluid social interaction. We hope
that the assessment and intervention approaches discussed in this book will not be applied too rigidly, and that
they are used with respect and consideration for the children they are intended to help.
We struggled with the book because the emotional complexity of relationships can never be truly captured
in writing. The importance of relationships to optimize social and communication development must be
inferred between the lines, and we hope that this cardinal rule is not forgotten. In the first edition, a reminder
of the emotional needs of a child was embedded into the discussion of challenging behaviors. In this edition, the
reader will find this summary at the very beginning of the book.
It is our hope that this book will expand and refine your approach to intervention, and that these ideas will
interface with other treatment options available. It is important that this text be viewed as a set of guidelines
and not a dogma of must do. Please use this information flexibly, and let intuition lead your efforts. If this is
done for the children, we will feel more satisfied with this finished product.

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The Emotional Needs of the Child

Although it is very tempting to outline a course of strategies for teaching social and communication skills to
children with autism, it is unreasonable to assume that the path of intervention will be straight or easy.
Meeting each child’s emotional needs ultimately drives the development of socialization and communication.
Socialization and communication are the products of relationships.
The basic emotional needs of all individuals include forming attachments and experiencing affection,
respect, empathy, comfort, compromise, safety, success, and joy. One’s emotional well-being must always be
considered during intervention. In order to meet the emotional needs of children and youth with autism, it is
essential to understand their sometimes unique ways of communicating and forming relationships. This is not
an easy task, as it is often difficult to interpret their emotional signals. Unlike typically developing children,
there is sometimes a mismatch between their behaviors and feelings. For example, someone with autism may
repeatedly ask a question that appears merely to be a perseverative inquiry. Nonetheless, the accompanying
behavior may actually indicate that he or she is feeling an intense amount of anxiety and is unable to
communicate his or her feelings in another way. Only through careful observation and sensitive listening can
each child’s emotional needs be understood over time. When working with children and youth with autism,
consider the following nine important areas for emotional well-being:
1. Attachments: Children with autism are often asked to work and interact with many different adults in
many different settings. This usually exceeds what is expected of typically developing children. The
number of people and settings in the child’s life, as well as the impact this has on his or her level of
comfort, need to be examined. Relationships take time.
2. Affection: There are many ways of communicating affection. It can be expressed through touch, a song, or
a smile. Individuals with autism sometimes respond to affection in unusual ways. One child may seek a
hug one minute, then pull away in the next minute. It is important to note the types of social feedback
each child enjoys. A match between the child’s personal preferences and the way in which affection is
expressed will enhance his or her social relationships.
3. Respect: Respect can be expressed through careful observation, astute listening, and flexibility.
Acknowledge all of a child’s efforts, even those that lack social appropriateness. Respect the child with
autism by offering choices whenever possible. Respect that some social situations are very difficult for
them by providing instructional supports. Balance the day’s activities between those that build self-esteem
and those that are difficult. Realize that more intervention is not always better on a particular day.
4. Empathy: Empathy is expressed by focusing on each child’s strengths, establishing realistic expectations,
and understanding the source of his or her confusion and discomfort. Empathy is expressed by including
emotional needs in the functional analysis of behavior and by teaching peers to be sensitive to others. In
addition, empathy is expressed by accepting that children do the best they can at the moment.
5. Comfort: Children learn in situations where they are comfortable. Intervention that diminishes the chaos
will comfort those with autism. They are further comforted when their feelings are acknowledged and
labeled. In addition, providing them with a private place to relax supports and comforts them.
6. Compromise: Imagine being a child with autism for one minute. Imagine the perceived confusion, the
overwhelming fear. Imagine not understanding the perspective of adults who control the day’s activities.
Imagine not understanding how to ask them to stop. It is essential to learn how much to push, when to
balance the needs of the child with autism with the needs of others, and when to compromise

12
 expectations. Compromise is possible when intervention is approached from a sympathetic point of view.
7. Safety: This is a promise to the child that “I will not let you hurt yourself or others” and “I will only use
physical prompting if necessary.” It also provides reasonable rules and boundaries.
8. Success: Feelings of mastery contribute to emotional well-being. It is important to balance the day
between pleasurable, mastered activities and challenging situations. All small successes and efforts need to
be acknowledged and praised. There are a thousand ways to praise someone. It is important to avoid the
habit of empty praise; instead, use praise that is genuine and natural. Social success is also defined by social
acceptance. Teach peers altruistic behaviors. Find opportunities for the child with autism to give and be
thanked by others. Encourage relationships with peers that are mutually satisfying.
9. Joy: What makes this child happiest? Allow him or her moments of joy that are independent of social
appropriateness every day. This ensures that communication, social, and emotional development will
continue.

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To all the individuals who have touched our lives for so many years, thank you.

Kathleen Ann Quill, Ed.D., BCBA-D

and
L. Lynn Stansberry Brusnahan, Ph.D.

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 CHAPTER 1

Understanding the Complexity of Autism

LEARNING GOALS:
1. Acquire a historical overview and learn the contemporary implications of autism spectrum disorder and
how our understanding of autism has evolved.
• Provide a timeline of the history of autism spectrum disorder that includes seminal researchers and
their contributions.
• Describe how theoretical perspectives can guide intervention (e.g., how the “refrigerator mother”
mindset led to institutionalization).
• Recognize how society has moved philosophically from providing interventions through an exclusion
model to the more contemporary model of inclusion.
• Report the possible etiology (i.e., cause) of autism spectrum disorder.
• Discuss the prevalence of individuals identified with autism spectrum disorder.
2. Understand the process of identifying and diagnosing autism spectrum disorder.
• Define autism spectrum disorder.
• Describe the key feature areas used in the medical criteria for diagnosing autism spectrum disorder.
• Explain how education needs must be identified to qualify for special education services.
• Compare the similarities and differences between a medical diagnosis and meeting criteria for special
education services under the educational category of autism spectrum disorder.
• Identify the common types of comorbidity that can accompany autism spectrum disorder.
3. Identify the social, communication, and behavioral characteristics typically associated with autism
spectrum disorder.
• Describe the cognitive features associated with autism with regard to attention, information
processing, and social cognition challenges.
• Understand satisfactory working theoretical explanations for the core features of autism, specifically
theory of executive dysfunction, weak central coherence, and mindblindness.

4. Articulate the complexity of autism spectrum disorder.

A utism is a lifelong disorder characterized by challenges in the areas of social interaction and
communication along with restricted, repetitive behavior, interests, or actions (American Psychiatric
Association [APA], 2013). This edition will describe the complexity of typical social and
communication development and articulate the challenges that individuals with autism spectrum disorder
(ASD) experience in these areas. In this edition, individuals with autism are referred to using a variety of
terms (e.g., child, youth, student, learner). The characteristics and strategies highlighted in this edition may be
applicable for individuals with autism across the lifespan regardless of age. This first chapter lays the

15
foundation for understanding ASD, providing a historical and contemporary overview, identification and
diagnosis criteria, and some of the major satisfactory working theories and cognitive explanations related to
ASD.

HISTORICAL OVERVIEW AND CONTEMPORARY

IMPLICATIONS OF AUTISM
This section includes a brief historical overview and discussion of etiology, prognosis, and prevalence of ASD.
Philosophical views on the disorder have an impact on intervention practices, so it is important to understand
how our perceptions, theories, and understanding of autism have evolved over time. Through the years,
society has moved philosophically from an exclusion model to the more contemporary model of inclusion.

Historical Overview of Autism

Autism is derived from the Greek word autos, meaning self. Autism was not recognized as a distinct disability
until the mid-20th century. In 1943, Leo Kanner, a psychiatrist at Johns Hopkins University, described the
challenges inherent in 11 of his patients. In this seminal study, Kanner noted that his patients shared similar
characteristics but their pattern of challenges appeared different from other conditions. Dr. Kanner considered
social withdrawal to be one of the primary features and labeled the disorder early infantile autism. Kanner
referred to the “autistic aloneness” in his patients as the inability to relate to people and situations. Kanner also
noted an obsessive insistence on sameness and included this trait in his descriptions of autism. The current
definition of autism and the diagnostic criteria remain consistent with many of the characteristics first
described by Kanner.
Around the same time, Hans Asperger (1944), a pediatrician at Vienna University Hospital, identified
patients with characteristics that included an absence of empathy for others, one-sided conversations, and
intense interests; his patients also demonstrated marked social challenges. Asperger’s patients possessed
average to above-average intellectual (cognitive) skills with no significant delays in language development.
Asperger used the term “autistic psychopathy” when referring to these patients. Through the 1960s, the
medical community thought of autism as a form of psychosis linked to “childhood schizophrenia” and
excluded individuals from society through institutionalization.

Etiology and Medical History Since autism was first identified, our understanding of the disorder has
grown, and the medical community continues to conduct research on the etiology (i.e., cause). Historically,
there have been a number of theories regarding the etiology of autism. Throughout the 1950s and 1960s,
autism was attributed to an absence of adequate environmental support. In his book An Empty Fortress (1967),
psychologist Bruno Bettelheim advanced this emotional deprivation theory and wrote about the cold and
rejecting upper-middle-class parents who were unable to psychologically bond with their children. This
psychogenic (i.e., of mental origin) theory placed blame for autism specifically on the mother of the child, who
was referred to as a “refrigerator mother” (Pollak, 1997). It was speculated that the parents’ withholding of
affection or negative feelings toward their child caused the child to retreat into autism. During this period,
medical professionals recommended children be removed from their homes and institutionalized, along with
the parents receiving psychoanalysis.
In 1964, Bernard Rimland, a psychologist and parent of a son with autism, presented the first solid
argument to refute the blame on the parent–child bond and published Infantile Autism and Its Implications for a
Neural Theory of Behavior, stressing the plausibility of a biological causation. To advocate for education and
end institutionalization, Dr. Rimland joined together with parents of children with autism across the country
and founded the Autism Society of America (formerly the National Society for Autistic Children). Since
1965, this grassroots organization has grown into a leading source of information and support to improve the
lives of all affected by autism.
In 1980, the APA defined infantile autism as a cluster of pervasive development disorders (PDDs) and
declared it a separate category from childhood schizophrenia in the Diagnostic and Statistical Manual of Mental
Disorders, Third Edition (DSM-III). In a 1987 revision, infantile autism was changed to autistic disorder. In
1994, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) added the category
of PDDs with five subtypes, which included autistic disorder, Asperger’s disorder, PDDs-not otherwise
specified (PDD-NOS), Rett disorder, and childhood disintegrative disorder. In 2013, the Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) consolidated the previous subtypes under the
broader heading autism spectrum disorder, which replaced the term PDDs. In this text, the terms autism
spectrum disorder, ASD, and autism will be used interchangeably.

16
 Currently, autism is considered a neurodevelopmental disorder. The term neuro is used because research
has revealed that specific structures of the brain do not function as expected in individuals with autism, and
developmental is used because children with autism do not meet typical milestones in some areas of skill
development. Some professionals believe that to treat autism, we need to intervene with whole-body strategies
and not just focus on the brain (Herbert, 2012).
The puzzle of autism continues as researchers seek to uncover the etiology of the disorder. Considering
the complexity of the disorder and how characteristics and severity vary, autism may not result from a single
root cause (Happé, Ronald, & Plomin, 2006). Rather, there could be many causal factors eventually
implicated. Research is ongoing to identify the underlying (e.g., genetic, environmental, neurological)
explanations for autism.
Medical conditions such as fragile X syndrome may explain the autism characteristics in a small percentage
of individuals (Hagerman, Rivera, & Hagerman, 2008). Sibling and twin research has demonstrated risk for
autism in additional family members, leading researchers to seek answers about genetic factors that may play a
role in causation for some with autism (Tick, Bolton, Happé, Rutter, & Rijsdijk, 2016). Genes by themselves
probably cannot explain the complex etiology of ASD, and it is unlikely that a single gene that causes autism
will be found. It is more likely that researchers may identify several susceptible (vulnerable) genes contributing
to autism characteristics (Rapin, 2008).
The high incidence of seizures in individuals with autism (Boutros, Lajiness-O’Neill, Zillgitt, Richard, &
Bowyer, 2015) has steered some researchers to explore an organic framework for autism. There has been
speculation about environmental factors playing a role in the disorder, with research linking autism to prenatal
influences (e.g., maternal infection during pregnancy), birth complications (e.g., oxygen deprivation), and
toxic chemicals (e.g., lead) (Landrigan, Lambertini, & Birnbaum, 2012). Much debate also has occurred about
an association between autism and vaccinations. To date, research finds no evidence of a causal association
between the two (Institute of Medicine, 2011; Taylor, Swerdfeger, & Eslick, 2014).
Regardless of etiology, scientists have discovered differences in the brain’s structures, functioning, and
development in individuals with ASD (Stoner et al., 2014). It appears there are early differences in the way
the brain grows and develops in the prenatal period, and increased head size has been found in some children
with ASD. Differences have also been noted in specific areas of the brain (e.g., cerebral cortex, basal ganglia,
amygdala, hippocampus, corpus callosum, cerebellum, brainstem), with multiple regions likely involved
(Minshew, Scherf, Behrmann, & Humpreys, 2011). Research continues, and organizations like Autism
Speaks raise money to fund research into the causes of the disorder.

Educational History With the 1990 revision of the Individuals with Disabilities Education Act (IDEA),
autism was identified as a discrete disability category eligible for special education services. With the federal
mandate for free and appropriate public education (FAPE), students with autism are required to be educated
in the least restrictive environment (LRE), which includes the general education classrooms as part of the
continuum of placement and service options available. The history of educational practice for learners with
autism has been characterized by controversy regarding different approaches grounded in divergent
philosophies.
Examples of these conflicting approaches include behavioral interventions grounded in applied behavior
analysis (ABA) versus relationship-based approaches grounded in developmental psychology. Psychology
professor Ole Ivar Lovaas was a pioneer in behaviorism in the field of autism. In the beginning, Lovaas
applied the experimental behavior analysis developed by Skinner to individuals with disabilities who
experienced self-injurious behaviors (Lovaas, Freitag, Gold, & Kassorla, 1965). Later, Lovaas (1987)
refocused his behavior modification efforts, providing intensive discrete trial training to children with autism
in their homes. As another approach, Stanley Greenspan developed a developmental relationship-based model
(i.e., Floortime) for children with a variety of developmental delays, including autism (Greenspan & Wieder,
2006). Rather than actively attempting to shape or direct a child’s behavior, the Floortime approach is more
child-directed and involves engaging the child naturally in his or her world. There has been considerable
debate over these two approaches. On one side of the debate, “those who believe that Floortime is the better
way still paint ABA as consisting of rote and repetitious drills that stifle the child’s spirit. On the other side,
critics of Floortime see it as a vestige of the old psychoanalytical school, lacking scientific credibility and
unable to present a coherent or reproducible methodology” (Maurice & O’Hanlon, 2010, p. 1). Despite
continued controversy, both of these approaches remain in practice today, along with additional singular and
mixed approaches grounded in a melding of divergent philosophies. Intervention practices are discussed in
detail in Chapter 4.

Contemporary Implications of Autism

17
With the Civil Rights movement and parent advocacy, society’s views have shifted from a segregated
institutionalization mindset to an understanding of the importance of home, school, and community
participation. Mindsets and theories can guide intervention. High expectations and a presumption of
competency can help people on the spectrum receive the supports they need to experience a higher quality of
life. High-functioning adults with autism (e.g., Temple Grandin) demonstrate the potential of individuals on
the spectrum and the importance of early intervention and education (Grandin, 2011). Inclusive education has
shown benefits to students with autism, particularly with regard to social engagement (Sansosti & Sansosti,
2012). This philosophical movement from exclusionary practices to the more inclusive contemporary models
of today has received increased attention and importance with the growing numbers of people being identified
with ASD (Ferraioli & Harris, 2011).
Prevalence ASD affects all racial, ethnic, and socioeconomic groups, with the disorder more common
among males than females. Prevalence refers to the total numbers of cases of a disorder in a specified
population at a particular point in time. When examining the 10-year time period between 2000 and 2010,
the Centers for Disease Control and Prevention (CDC; 2014) reported that prevalence numbers were
estimated to have grown from 1 in 150 to 1 in 68. When examining the school years from 1991–1992 to
2011–2012, the U.S. Department of Education reported that the number of students receiving special
education services for autism grew from 5,000 to 455,000 (Snyder & Dillow, 2012). The reasons for this rise
are complex and not clear (Hyman & Levy, 2013). Possible explanations for this increase include a broader
definition of ASD, better diagnostic procedures, greater awareness, and the realization that ASD may co-
occur with other disabilities. Regardless of the explanation, there appears to be an authentic increase in the
number of people with autism. This upsurge in prevalence has focused professionals on increasing efforts to
identify the etiology of autism and to determine which evidence-based practices (EBPs) meet the needs of this
unique and diverse population (Chakrabarti & Fombonne, 2005).
Prognosis Most of the research conducted to date paints a poor prognosis for individuals on the spectrum
across adaptive behaviors at all levels of severity (Howlin, Savage, Moss, Tempier, & Rutter, 2014; Magiati,
Tay, & Howlin, 2014; Tsatanis, 2003; Van Heijst & Geurts, 2014). Adaptive behaviors include 1) daily living
and independent living skills, 2) social and interpersonal skills, 3) communication skills, 4) academic skills, 5)
recreation and leisure skills, 6) community participation skills, and 7) work and work-related skills. Long-term
follow-up studies show that the majority of adults with autism do not achieve independence, full-time
employment, and social relationships (Howlin & Moss, 2012). Even though research currently portrays
individuals with autism experiencing poor outcomes, there is evidence that people with autism can learn to
live, work, and become contributing members of their communities (Schall, Wehman, & Carr, 2014). To
improve the prognosis and contribute to more positive outcomes for people with autism, increased emphasis is
now placed on intensive and individualized intervention starting in early childhood that addresses the core
social and communication challenges.

IDENTIFYING AND DIAGNOSING AUTISM

The definition of and criteria for autism vary across particular fields, programs, or services. This section
presents information on medical diagnosis, early identification, coexisting conditions, and special education
eligibility criteria.

Medical Diagnosis
The medical profession is responsible for the medical diagnosis of autism, utilizing the classification schemes
and diagnostic criteria in the APA’s DSM or the World Health Organization’s (WHO) International
Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10; 2016). This text focuses on the
DSM-5 criteria.
The DSM-5 requires medical professionals to identify persistent deficits in two areas. These include
deficits in social communication and social interaction plus restricted, repetitive patterns of behavior, interests,
or activities (see Figure 1.1). Individuals diagnosed with autism experience a range of intellectual functioning,
and the severity of their social, communication, and behavior challenges varies significantly. Because autism
affects each individual differently, one intervention approach may not benefit all equally. In order to develop
effective intervention strategies, an understanding of this complex developmental disorder is necessary. The
following vignettes highlight the diversity of the spectrum and how socialization, communication, and
behavior differ significantly among children with autism.

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Figure 1.1. Main diagnostic criteria for Autism Spectrum Disorder. (Source: American Psychiatric Association, 2013)

Ahmed’s language development has followed typical milestones in terms of vocabulary and sentence complexity. He
loves to talk about numbers and television commercials. He collects and carries objects—always blue. He plays alone
and is very adept with constructive activities and puzzles. He will put together a difficult puzzle and then put it
away without sharing his accomplishment with anyone. He watches peers socializing, but he has not been observed to
initiate or respond to social interactions with them even though he states that he would like to have a friend. His
parents report that it is difficult to engage their son in various topics of conversation outside of his own interests or to
have a back-and-forth conversation with him. It appears that his fixation on talking about numbers or commercials
incessantly is interfering with his ability to make friends.

Bruno’s language is delayed, and he currently speaks in one- or two-word phrases or repeats what he hears (echolalia).
He recites segments from his favorite movies. Although he has some language, he does not use gestures such as waving
hello or goodbye or using his index finger to point. He likes to line up items, including toys and cereal boxes. He has
loud verbal outbursts if his activity is interrupted or there is a change in his routine. He currently is not watching peers
or interacting with them.

Chen does not make eye contact when someone says his name or talks to him. He is nonverbal and his only
vocalizations occur when he is protesting and crying. He does not use gestures to indicate that he wants something.
Instead, he pulls and pushes adults to make basic requests, or he independently gets what he needs. He occupies his time
with ribbons, string, and any object that twirls and will push away anyone who tries to socially interact with him.
Chen will plop himself down on the floor if someone tries to divert him from his special interest items. He has difficulty
sleeping through the night. His parents note that he has an extremely limited diet, and he eats the same food items
every day. Chen runs away or covers his ears in the presence of peers or will flap his hands when an environment
becomes loud. His parents state that he has trouble understanding both their spoken and nonverbal communication.
For example, the parents have tried to use a stern look with him when saying “no” to note their disapproval of his
behavior, but he doesn’t seem to understand the meaning of their facial expression or words.

Each of these children displays the complex social and communication differences and repetitive behaviors
associated with autism, but in distinct ways. The DSM-5 criteria require that professionals report on the
severity of an individual’s challenges by choosing one of three levels of required supports (APA, 2013):
• Level 1: The person needs support.
• Level 2: The person needs substantial support.
• Level 3: The person needs very substantial support.
In the vignette examples, Ahmed’s social and communication difficulties require support, whereas his
restricted, repetitive patterns of behavior are more severe and require substantial support. Bruno displays
challenges in social and communication development that require substantial intervention, whereas his
restricted, repetitive behaviors require support. Chen requires very substantial intervention in all areas. The
profiles of these three children reflect the unique range of challenges and needs that accompany autism.

Early Identification
There is no specific medical test to diagnose ASD. Professionals look for a cluster of behavioral characteristics
to identify autism. Identification of ASD can be made reliably at an early age (e.g., approximately age 2 years)
(Chawarska, Klin, Paul, & Volkmar, 2007; Klin et al., 2004; Osterling, Dawson, & Munson, 2002). Early
detection and medical diagnosis of autism generally begin and can be confirmed through parental concerns
(Beauchesne & Kelley, 2004). Identification involves two steps. The first step includes developmental
screening and surveillance. The second step is a comprehensive diagnostic evaluation.
Medical professionals screen for and monitor children for the presence of a developmental disability
(Johnson & Myers, 2007). Screening can include developmental, domain-specific, and disability-specific
instruments. Screenings involve administering a brief standardized tool to aid in identifying risk for a

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developmental disorder. Medical professionals generally start with universal developmental screening
instruments that examine multiple domain areas. These instruments, which are used with all children during
developmental checkups, have thresholds at which professionals make decisions about moving forward with
continued assessment. When warning signs or red flags are seen, professionals may move forward to the next
level of screening and examine domain-specific challenges, such as communication, or disability-specific
challenges, such as autism.
If a child is identified as “at risk” during screening, professionals should refer a family to a medical
specialist with expertise in the suspected challenge area for a more comprehensive diagnostic assessment and
evaluation (e.g., referral to a speech and language pathologist if there is a speech delay; referral to a
psychologist if autism is suspected). The ultimate aim is to identify the specific disorder or challenge affecting
the child’s development so that the child and family may have access to specific intervention. Research on the
impact of early intervention services has shown positive benefits with intervention, increasing social,
communication (e.g., verbal ability), intellectual, and adaptive functioning while also reducing the severity of
autism characteristics (e.g., Hayward, Eikeseth, Gale, & Morgan, 2009; Howard, Sparkman, Cohen, Green,
& Stainslaw, 2005; Itzchak & Zachor, 2011; Vernon, Koegel, Dauterman, & Stolen, 2012).

Coexisting Conditions
ASD can occur in association with other developmental disabilities; mental health disorders; medical
conditions; and a wide range of motor, language, and cognitive impairments (Filipek et al., 2000). When two
or more clinical diagnoses are experienced in one individual, this is referred to as comorbidity, coexistence, or
simultaneous co-occurrence.
Mental health disorders such as mood disorders and conduct disorders have been identified in some
people with ASD (Gadow, DeVincent, Pomeroy, & Azizian, 2004). Some individuals with ASD also
demonstrate signs of attention deficit disorders (Leyfer et al., 2006). Medical conditions such as seizures are
sometimes associated with autism (Tuchman, Hirtz, & Mamounas, 2013). Motor challenges in individuals
with ASD can range from motor planning difficulties to severe dyspraxia (Fournier, Hass, Naik, Lodha, &
Cauraugh, 2010; Gidley Larson & Mostofsky, 2006). Dyspraxia is a form of developmental coordination
disorder affecting fine- and/or gross-motor coordination, which may affect speech. Challenges in language
vary widely within ASD, from delay or absence of spoken language to atypical language acquisition (Lord,
Risi, & Pickles, 2004). Some individuals with autism remain nonspeaking for their lifetime. Other children
may start speaking as a toddler but later lose or regress in spoken language (Werner & Dawson, 2005).
Individuals with ASD have been reported to have impaired conversational and narrative skills and/or
differences in their semantic and pragmatic language development (Tager-Flusberg, Paul, & Lord, 2005).
Autism can also be associated with a cognitive (intellectual) disability (Dykens & Lense, 2011).
The DSM-5 requires medical professionals, when diagnosing a person with ASD, to specify whether or
not the disorder is associated with the following:
• Intellectual impairment
• Language impairment
• A known medical or genetic condition or environmental factor
• A specific neurodevelopmental, mental, or behavioral disorder
• Catatonia
Catatonia is a term used to refer to a cluster of behavioral features manifested as motor, vocal, and affective
symptoms (Ghaziuddin, Dhossche, & Marcotte, 2012). For example, common symptoms include absence of
speech, slowness in movement, difficulty initiating and completing actions, lack of motivation or passivity,
and increased reliance on prompting by others. Each of the possible coexisting conditions and developmental
differences contributes to the tremendous variability observed in autism.

Educational Eligibility
Educators have a responsibility to screen for and identify children with suspected disabilities. In the United
States, a law enacted as the Education for All Handicapped Children Act of 1975, and changed in 1990 to the
Individuals with Disabilities Education Act (IDEA), mandates referral for educational intervention when
concerns are raised.
• When a child is younger than 36 months of age, he or she is generally referred to the birth/zero-to-three
service system in the community.

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• At age 36 months and older, children are generally referred to local school districts for an evaluation.
Educational professionals are responsible for determining eligibility under the category of ASD for special
education and related services. Meeting criteria for educational services is different from receiving a medical
diagnosis of a disability. Just because a student has a medical diagnosis of ASD does not mean he or she will
automatically be eligible for special education services. Each state has its own criteria for eligibility mandated
by IDEA. Students must meet the educational criteria and demonstrate educational need to receive special
education services. IDEA has four sections (A, B, C, and D) that govern how states and public agencies
provide early intervention, special education, and related services to eligible infants, toddlers, children, and
youth with disabilities (U.S. Department of Education, 2010):
• IDEA Part B ensures special education and related services for children and youth (ages 3–21).
• IDEA Part C ensures intervention services for infants and toddlers with disabilities (birth through age 2)
and their families.
Many young children with autism are initially serviced under the category of developmental delay. This
category is used for at-risk infants or toddlers who would be at risk of experiencing substantial developmental
delay if early intervention services were not provided (IDEA, 2004). States can choose how they want to
assign disability categories as long as they cover all of the federal disability terms and definitions. For young
children moving from early intervention services to preschool, the criteria that initially qualified them for
services may not be the same as the criteria that make them eligible for public school services when they turn 3
years of age.
Federally, autism is defined within education as a developmental disability significantly affecting verbal
and nonverbal communication and social interaction, generally evident in childhood (e.g., before age 3 years),
that adversely affects a child’s educational performance (IDEA, 2004). Because the educational definition
requires autism to be generally evident in childhood, a developmental history is necessary as part of assessing
eligibility for educational services. A developmental history consists of interviewing parents, providing
instruments to parents with questions about early developmental milestones, and reviewing available medical
records. The federal definition notes other characteristics often associated with autism, including engagement
in repetitive activities and stereotyped movements, resistance to environmental change or change in daily
routines, and unusual responses to sensory experiences.

COGNITION IN AUTISM
Research suggests that some people with autism have uneven cognitive profiles, with variation between verbal
intellectual and nonverbal intellectual measures of cognitive functioning when compared to peers with and
without disabilities (Coolican, Bryson, & Zwaigenbaum, 2008; Joseph, Tager-Flusberg, & Lord, 2002;
Kuschner, Bennetto, & Yost, 2007). The cognitive patterns associated with autism include a tendency to
interpret information in a fragmented manner, misperceive the perspectives of others, focus on details, and
become “stuck” in one mode of thinking and behaving. These cognitive patterns can cause individuals with
autism to misinterpret the meaning of experiences, which can lead to challenges with social reasoning and
cognitive flexibility (i.e., the ability to shift between different thoughts or actions depending on situational
demands and tasks; Geurts, Corbett, & Solomon, 2009). In addition, learning and social and communication
skills may become self-directed and intensely ritualized (Bodfish, 2011). The cognitive challenges that people
with autism face lie on a continuum, with severity measured as the degree to which each of these cognitive
processes dominates thinking and behavior (Brunsdon & Happé, 2013). Table 1.1 presents an overview of
cognition in autism, describing challenges in three cognitive areas: attention, information processing, and
social cognition. Cognitive traits link to current working theories that explain the common characteristics of
autism.

Table 1.1. Overview of cognition in autism

Cognitive trait Associated theory Cognitive characteristics present in autism Challenges in autism
Attention Executive dysfunction Focused attention Social attention
Overselective attention Joint attention
Shifting attention
Information processing Weak central coherence Repetitive patterns Cognitive flexibility
Visual processing Auditory processing
Attention to detail Integrating information
Concrete thinking Abstract thinking
Gestalt processing Analytical thinking
Rote learning Recall
Social cognition Theory of mindblindness Literal language Theory of mind
Systemizing Empathizing

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 Since it was first identified, autism has been explained by a host of hypotheses resting on cognitive,
psychological, and behavioral theories. No singular explanation exists for all of the core features of autism.
Some claims have been discredited, such as the “refrigerator mother” theory. Current theories that address the
different aspects of autism can be thought of as “satisfactory working theories” (Happé & Ronald, 2008). In
addition to providing cognitive explanations for behaviors associated with autism in the areas of attention,
information processing, and social cognition, this section presents related major satisfactory working theories
behind the features of autism: executive dysfunction, weak central coherence, and mindblindness. Although
each of these theories improves our understanding of autism, none addresses the entire complexity of the
spectrum.

Attention
In order to attend to others, it is necessary to feel comfortable, filter out distractions, and know what is
relevant. An experience must be either interesting or meaningful to maintain some level of attention.
Attention to a novel or confusing situation requires a degree of internal motivation and/or external
reinforcement. The failure to attend to a social stimulus can reflect a lack of motivation and/or an
understanding of its relevance. In the absence of motivation (i.e., internal or external reinforcement) and
meaning (i.e., understanding the experience), interest and attention may be lost. The cognitive trait of
attention falls under the broad umbrella of executive functioning, and the theory to explain problems with
attention seen in autism is referred to as executive dysfunction.
Theory of Executive Dysfunction Executive function is the term used to describe multiple cognitive
processes that are crucial for planning and carrying out goal-directed behavior and problem solving in the face
of distractions (Fisher & Happé, 2005). Executive function might be thought of as the chief executive officer
of the brain. It organizes, controls, and directs all thinking and physical activity. Executive function allows for
the regulation of attention, thoughts, and behaviors in all contexts (Carlson, 2009; Kenworthy, Yerys,
Anthony, & Wallace, 2008). Executive function enables an individual to start (plan, initiate, and sequence),
stop (inhibitory control and disengage attention), and switch (mental flexibility and shift focus of attention)
while engaged in a task (Robinson, Goddard, Dritschel, Wisley, & Howlin, 2009).
The theory of executive dysfunction explains challenges with a wide range of executive functioning skills.
People with autism exhibit difficulties with all aspects of executive function, including initiation, regulating
attention, attending to others, attending to multiple cues, and shifting attention (Corbett, Constantine,
Hendren, Rocke, & Ozonoff, 2009; Geurts, Verté, Oosterlaan, Roeyers, & Sergeant, 2004; Liss et al., 2001;
Rosenthal et al., 2013). Executive dysfunction in individuals with autism is exhibited as repetitive behaviors,
cognitive inflexibility, and social communication challenges. These difficulties impact all areas of learning and
behavior, particularly social competence. Particular attention challenges resulting from executive dysfunction
include problems with social attention, overselective attention, and problems shifting attention.
Social Attention One developmental theory suggests that early attention challenges deprive children with
autism of essential social information, thus disrupting social and cognitive development (Mundy & Newell,
2007). Research indicates that people with autism experience differences in the way in which they attend to
people and faces during social interaction (Hanley et al., 2014; Riby, Doherty-Sneddon, & Whittle, 2012).
Some of the earliest signs of autism include impaired or absent social orienting, joint attention, and attention
to the emotions of others (Dawson et al., 2004).
Social orienting occurs when a person spontaneously turns toward naturally occurring social stimuli in the
environment; for example, turning toward someone who has just said your name. Joint attention refers to
coordinating attention between social partners and objects or events to share awareness and experiences. Joint
attention is displayed by looking at where another person is pointing and then looking back at the person to
share an emotion related to the shared experience. Attention to the emotions of others occurs when an individual
simultaneously notices the saliency of another person’s emotion and can link the meaning of the emotional
expression to the social context.
Retrospective studies of first birthday home videos have shown that infants later diagnosed with autism
fail to orient to their names, demonstrate a lack of joint attention, and attend infrequently to others’ social and
emotional messages (Osterling et al., 2002). Expressions of emotion have a communicatory function and
convey specific information (Blair, 2003). The majority of studies focusing on attending to emotions has been
centered on the face and basic emotions such as happiness, sadness, anger, surprise, fear, and disgust (Castelli,
2005; Tracy, Robins, Schriber, & Solomon, 2011). Research has revealed that attending to and recognizing
emotions is challenging for individuals with autism, with difficulties most apparent in the recognition of more
complex emotions (Golan, Baron-Cohen, & Golan, 2008; Nuske, Vivanti, & Dissanayake, 2013). Generally,

22
complex emotions involve attributing a cognitive mental state to an emotion and are more dependent on
context and culture. Examples of complex emotions are embarrassment, discomfort, shock, worry, temptation,
relief, guilt, excitement, and loneliness. The following vignettes illustrate social attention challenges.

Jillian often engaged in solitary activity with a number of preferred items. During this activity, she was frequently
unresponsive to those around her. Her mother would try to get Jillian’s attention before calling her name by
interrupting her activity or placing her hands over Jillian’s item. This frequently caused Jillian to become agitated and
further withdraw from interaction by trying to cover the items her mother was not holding. Subsequently, Jillian’s
mother tried to draw the child’s attention by tapping Jillian’s hand lightly and then drawing her daughter’s finger
toward her face. This strategy worked when Jillian was seated at the table, but not in other less structured settings.
Jillian’s teacher recommended that her mother try snapping when calling Jillian’s name. Jillian was highly motivated
by auditory input and found silly noises amusing. When her mother tried it, Jillian readily oriented to the noise. She
reinforced Jillian for looking and, over time, faded the snapping.

Tyler would focus on the fibers in the rug rather than on toys during play and leisure activities. His teacher tried
prompting him to attend by telling him “Look,” coupled with a finger point. Tyler’s response was inconsistent, so his
teacher began to play with the toy herself, rolling the car back and forth in front of Tyler while making animated
engine noises. Tyler oriented to the noise. While she had Tyler’s attention, she rolled the car lightly over her foot and
stopped it in front of him. Tyler looked at the car and then at the teacher. The teacher held her foot and puckered her
lips to look like she was going to cry. Tyler did not respond to the emotion of the teacher. He does not gather
information with his eyes to reference others’ emotions. He can identify emotions when shown photographs of people’s
faces. He can even hold a mirror and illustrate different basic emotions, such as happy and sad, on his own face. He
struggles, however, to distinguish among more complex emotions such as frustration, pride, or embarrassment.

Overselective Attention Research reveals that people with autism demonstrate differences in their
capacity for attention. One such difference is referred to as overselectivity, which is a restricted ability to
simultaneously attend to multiple cues in order to make sense of incoming information (Broomfield,
McHugh, & Reed, 2008; Leader, Loughnane, McMoreland, & Reed, 2009; Ploog, 2010). Overselective
attention results in a tendency for some people with autism to process information one piece at a time.
Material often is stored and remembered as a whole or gestalt rather than reorganized and integrated in a
flexible manner. With overly selective attention, an individual may attend to a limited number of cues and
have difficulty determining the most meaningful feature of a given stimulus, which can affect information
processing in situations consisting of complex or multiple cues (Reed, Altweck, Broomfield, Simpson, &
McHugh, 2012). Many times, the message or meaning is lost in the details or stops at the concrete level so
that the person misses important abstract connections. With these challenges, a narrow and more restricted
understanding of information emerges.
Individuals with autism may direct their focus on a single feature or be drawn to the same repetitive
stimuli as a result of overselectivity. Thus, the tendency to engage in repetitive behavior may be viewed, in
part, as a means to create order amid chaos. Firsthand accounts from people with autism often describe an
overwhelming experience of feeling bombarded by sensory input. Some report that, at times, they engage in a
defensive shutdown reaction and are only able to attend to a limited number of cues (Birch, 2003; Grandin,
2011; Miller, 2003; Sainsbury, 2000). Research has indicated that these hypersensitivities or atypical responses
to sensory stimulation can affect individuals in areas such as attention (Baranek et al., 2013; Brock et al., 2012;
Donkers et al., 2015). Sensory challenges can cause distractibility, disorganized thoughts, and discomfort in
people with autism. The result is a tendency to hyperfocus on sensory experiences that are pleasurable, engage
in repetitive behavior for sensory feedback, and ignore or avoid multisensory experiences that are
uncomfortable or confusing. The following vignettes illustrate some of the sensory challenges associated with
overselective attention.

Devon loves to sit and play on the beach in the sand for hours. He sifts the sand through his fingers and laughs.
Although he enjoys this tactile experience, he has a high degree of auditory sensitivity. While he seeks tactile sensory
input, he avoids auditory sensory input. He is able to watch videos only with the sound turned off; otherwise, he covers
his ears and cries at the sound.

Eduardo engages well with a wide range of activities at home and will attend for extended periods of time. In his
classroom, however, when there is a lot of sensory input, he engages in self-stimulatory flapping of his hands. The
discrepancy between skills seen at home and at school appears linked to the number of cues or amount of stimulation in
the environment. When he is overstimulated, he is unable to organize himself even during familiar activities.

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 Given that learning requires attention to multiple environmental features, difficulties with attention can
markedly impede development, particularly in the social domain. For example, understanding the meaning of
someone’s message requires attending simultaneously to the speaker’s words, facial expression, tone of voice,
and body gestures as well as the social context. People with autism may have difficulty determining the most
meaningful feature of a given stimulus and focus on less relevant cues (Berger, Aert, van Spaendonck, Cools,
& Teunisse, 2003). If the person is preoccupied or attending to only one cue, such as someone’s gestures, he
or she will be less likely to understand the full meaning of the social message. This attention to details often
translates into misinterpreting the meaning of the situation. The following vignettes illustrate some of the
challenges associated with attention to only one cue.

Ferdinand is having difficulty learning his numbers. He points to the correct answer only 50% of the time. Upon closer
examination, it is discovered that he always selects the card that is in the location of the previous correct answer. He
focuses on location, not meaning, in his effort to understand the task.

George is learning about money in math. When asked to tell the class what he would do with a nickel, he explains, “A
nickel is gray or silver. A nickel is a circle, and a nickel has a man on it with a jacket. The quarter has a man with no
jacket.” Henry recognizes the president’s attire on U.S. coins, but he has concentrated on details that are not socially
relevant and does not appear to understand the purpose of money.

Shifting Attention Sharing attention with others requires a person to rapidly shift his or her attention
between different stimuli. Research demonstrates that people with autism can have problems with shifting
attention between stimuli once attention has been engaged and with changing reactions in response to
circumstances (Geurts et al., 2009; Gioia, Isquith, Kenworthy, & Barton, 2002; Hill, 2004; Reed et al., 2012).
In autism, an impaired ability to flexibly shift attention is associated with executive dysfunction and can be
linked to restriction of interests (South, Ozonoff, & McMahon, 2007; Yerys et al., 2009) and difficulties with
language meaning and social interaction (Dawson et al., 2004; Landa & Goldberg, 2005). Shifting attention
requires cognitive flexibility, and cognitive flexibility requires multiple attention processes, all challenges in
autism (Corbett et al., 2009; Solomon, Ozonoff, Cummings, & Carter, 2008).
Studies of attention report that people with autism may be slow to shift attention between and within
different sensory modalities; shift attention toward and away from people less; and struggle to attend to
rapidly occurring sensory, language, and social events (Hutman, Chela, Gillespie-Lynch, & Sigman, 2012;
Ibañez, Messinger, Newell, Lambert, & Sheskin, 2008; Nadig et al., 2007). For example, individuals with
ASD may have trouble following the quick pace and complex features of social interaction (Mostert-
Kerckhoffs, Staal, Houben, & de Jonge, 2015). Some people with ASD have a tendency toward repetitive
behavior and an interest in restricted activities that do not change and may be unusual in intensity or focus
(Boyd, Conroy, Mancil, Nakao, & Alter, 2007). This desire for repetition or rituals may be an attempt to have
meaningful experiences amid confusing social stimuli. The following vignettes illustrate the characteristics and
behaviors associated with difficulties shifting attention.

Imad lines up the pieces of a puzzle in order according to shapes. He also lines up objects within the classroom,
including markers by color. At home, he lines up his mother’s shoes and his brother’s baseball cards. He can sustain
attention while involved in meaningful solitary leisure activities, but he has difficulty in social interaction or classroom
activities that require him to shift attention back and forth from his own activity to the activities of others.

Jacob’s attention varies during group time. He can maintain attention to the lesson if the teacher reads something from
beginning to end without interruption or if the lesson is an area of special interest to him. If the teacher interrupts a
lesson intermittently to ask questions, however, Jacob’s attention is lost, and he attempts to leave the classroom. He has
difficulty during discussions that require him to shift attention back and forth from one thing to the next, especially if
the teacher is asking him to shift his attention away from something in which he is especially interested.

Information Processing
Cognitive processing is a multilayered system in which information is analyzed, organized, stored, and
remembered in complex ways. A person instantly links a new experience to a number of related past
experiences. The following vignette illustrates how novel information reshapes and redefines all related
previous knowledge in a typically developing child.

A typically developing child sees a new animal. She notices all of the animal’s separate attributes through different
sensory channels, listens to language associated with the animal, and relates certain emotions with the animal. She

24
links all of the separate attributes to similar features in other animals (real and imaginary), assigns meaning to her
sensory perceptions, incorporates all of the pieces of language information into her existing body of knowledge about
animals, and creates a new and revised concept of animals. In a few moments, animals have a new meaning for the
child, and the information is stored in an infinite number of ways. This happens unconsciously and effortlessly. Most
important, because this animal concept is multilayered and connected to related experiences, there can be an infinite
number of ways to recall the new experience.

The way children with autism process information sharply contrasts with the complex and fluid style of
typical peers. Research has found that the information processing capacity in people with ASD is reduced or
constrained (Williams, Goldstein, & Minshew, 2006, 2013). Problems integrating information in meaningful
and flexible ways characterize the processing style of autism, termed weak central coherence.

Weak Central Coherence Central coherence is the term used to define a cluster of skills that allows people
to process and interpret information in context to determine meaning. An individual processes incoming
information with central coherence to extract the overall meaning of the situation but often at the expense of
attention to and memory for details. For example, when retelling a story, many people find it easier to
accurately recall the gist of the story rather than remember specific details.
Central coherence falls under the broad umbrella of information processing, and the theory of weak
central coherence explains many of the processing challenges in autism. Weak central coherence (WCC) is
analogous to the expression “not able to see the forest for the trees.” In other words, the person processes
information in a piecemeal fashion at the expense of contextual meaning. People with ASD may have an
enhanced ability to observe in a detail-focused way—processing the constituent parts, rather than the whole
(Happé & Frith, 2006). This concentrated focus on details results in difficulty assimilating information,
discovering meaning, and comprehending information (Constable, Grossi, Moniz, & Ryan, 2013). With
WCC, people with autism perceive pieces of an experience but fail to integrate the parts in a meaningful way.
They have the tendency to process one specific detail at a time and have difficulty determining the most
relevant features of a situation, creating a fragmented understanding of events (White, O’Reilly, & Frith,
2009). People with autism may also have trouble distinguishing important from unimportant details,
particularly in social contexts.
Social interaction demands flexible attention, an understanding of what is relevant, and the ability to
disregard what is not pertinent. It requires fluid processing of multiple contextual, language, social, and
emotional messages. People with autism struggle to simultaneously attend to and integrate the words,
emotional expression, tone of voice, and body gestures of social partners as well as to link these messages to all
of the relevant features of the social context in order to understand the whole meaning of a social situation. As
a result, they may respond in an irrelevant or overly literal manner (Klin & Jones, 2006). Specific information
processing differences associated with autism include context blindness, gestalt learning, detailed meaning,
concrete thinking, visual thinking, and memory recall.

Context Blindness Context blindness is another term used to describe the cognitive processing style of
people with autism. Context blindness is defined as a failure to use context spontaneously and subconsciously
to determine meaning. The theory of context blindness focuses on a person with autism having a keen eye for
details without reference to the context required for understanding. An analogy to explain this would be “not
using the forest to see the trees as being trees” (Vermeulen, 2015).
Context is the totality of all observed and inferred elements that influence perception and meaning. To
understand context, an individual must be able to discover relevant information while ignoring unimportant
details. The theory of context blindness proposes that people with autism tend to engage in fixed one-to-one
associations and struggle to recognize ongoing contextual changes and assimilate new information in a fluid,
meaningful way (Vermeulen, 2012). A one-to-one association means that a person with autism can struggle
making simple comparisons beyond the context in which information is initially acquired. That initial learning
becomes the defining and sometimes singular meaning of that information. The following vignettes illustrate
context blindness in autism.

When Katie is at a coffee shop, she runs into an acquaintance from church. At first glance, she does not recognize the
individual because he has acquired new glasses. She doesn’t process a whole person; instead, she first sees things
separately: the glasses, his clothes, and so forth. She then makes a conscious effort to assemble all of these and process the
information to figure out whom she is encountering. Because of her singular focus on individual details (e.g., a pair of
glasses), Katie finds it difficult to spontaneously recognize a familiar person after his initial appearance has changed.

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Leonard visited Washington D.C. on spring break. When he returns to school, his teacher asks him to draw a picture
about his trip. He draws a picture of the White House that includes lots and lots of windows. The teacher finds an
actual picture of the White House and counts the windows. Leonard has drawn every window and every single
window pane on the front of the White House. Due to context blindness, Leonard’s personal experiences with
Washington D.C. are narrowly associated with the White House windows rather than the totality of his trip.

Gestalt Learning Learning is an active cognitive process whereby experiences are assimilated into
complex networks of meaning. In the absence of understanding the integrated meaning of an experience or a
concept, information is merely stored as a gestalt whole, unrelated to anything else. A fundamental aspect of
the learning patterns of individuals with autism is that they tend to organize and remember information as a
whole rather than analyze the interrelated meaning of the parts (Bölte, Holtmann, Poustka, Scheurich, &
Schimdt, 2007). An example of gestalt learning in the general population is memorization of the Pledge of
Allegiance. Most people generally memorize the pledge as a whole without stopping to consider the meaning
of the individual words.
Gestalt processing, information remembered as a whole, generally reflects a decreased understanding of
the meaning of the parts. When people with autism are unable to extract meaning from information in a
flexible, integrated way, they are left with a series of fragmented experiences (Brosnan, Scott, Fox, & Pye,
2004). Gestalt processing is reflected in specific learning and behavior patterns. Repetitive patterns such as
echolalic speech and rigid conversation patterns typify gestalt processing (Stiegler, 2015). The following
vignettes illustrate these characteristics of gestalt learning.

Steven has learned the overall concept that conversation is an exchange between two people. He is still struggling,
however, with the meaning of the specific words he hears. For example, when his mother says, “Did you miss me at
school today?” he replies, “Missed me at school today.” If she then states, “No, say ‘I miss you,’” Steven answers, “Say I
miss you.” Steven does not understand the intricacies of responding to or interpreting the individual components of
conversation, so he repeats words back to his mother in an echolalic, verbatim manner.

Nena enjoys maps. The first time he generally meets someone, he asks, “What’s your name?” and “Where do you live?”
Then he checks his map and describes the route the person takes from his or her home to school. Each time he sees that
person—whether it is 1 hour, 1 day, 1 month, or 1 year later—he asks the same two questions, then smiles and details
the route. If the person happens to have moved, he becomes extremely agitated and demands that the person state the
old address in order to maintain the whole conversation as he remembers it. Comfort and pleasure are linked to these
gestalt, routinized conversational exchanges.

Detailed Meaning For decades, autism has been described as a challenge with understanding the
meaning of experiences. Detail focus or a propensity toward narrow and restricted conceptual understanding
characterizes the processing pattern observed in autism (Frith, 2012; Le Sourn-Bissaoui, Callies, Gierski, &
Mote, 2011). People with ASD may attend to specific, observable information and be less able to look beyond
pure perception to assign meaning to their experiences or the experiences of others (Frith & Frith, 2012). The
following vignette illustrates how the outcome can be a tendency to make illogical concrete associations,
especially with regard to social and emotional experiences.

Bryce, a child with autism, smiled when a peer told him her cousin had been run over by a car and had died. He was
thinking that he was glad that the person who had died was not someone close to him, and started thinking about a car
ride that he took and enjoyed. He did not realize that the emotion he was expressing was not appropriate in the context
of the emotions the other person in the interaction was experiencing.

In order to acquire meaning, particularly in social contexts, one must be able to

• Extract meaning from the multitude of contextual elements
• Infer meaning from the social cues of others
• Infer meaning from the emotional cues of others
• Assimilate what is experienced with existing knowledge
In autism, acquiring meaning can be affected by challenges with all four of these cognitive processes.
Concrete Thinking Generalized learning occurs when information is analyzed, organized, stored, and
remembered in multiple ways. In a single moment, a person attends to various aspects of a new experience and
then links it to an infinite number of related experiences. This novel information reshapes and redefines all

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related knowledge. In contrast, the information processing style of autism is characterized by concrete
thinking. With concrete thinking, there is a tendency to narrowly focus on one aspect of a situation.
Information is processed in a more restricted and thus less typically meaningful way. This concrete thinking or
limited ability to fluidly analyze and integrate (i.e., register, engage with, and adjust) information influences
social, communication, and cognitive flexibility (Hobson, 2012).
When learning is predominantly driven by concrete physical experiences, the result is an understanding of
the world of objects and a greater difficulty with abstract concepts, particularly social meaning. This is
commonly observed in the individual’s literal interpretation of situations. Because the individual’s experiences
are learned as a series of single events and are not connected to other related experiences or broader concepts,
the result is rote learning and responding. Furthermore, concrete thinking may cause social, communication,
and cognitive rigidity manifested by insistence on predictability and routinized interactions. The following
vignettes illustrate behaviors and characteristics associated with concrete thinking.

Odawaa learned to ask for a drink in school by bringing a photo of a yellow cup to his teacher. Although he mastered
this requesting skill in school, he never used the same communication symbol at home. His mother gradually realized
that there was a yellow cup for his drinks in school but not at home. For him, the photo of the yellow cup meant “yellow
cup,” not “drink.”

Peter’s mother understands her child’s way of thinking. His mother links each outing with a specific object so that her
child understands where he is going; for example, a straw bag symbolizes a trip to the market and a string of beads
means a trip to visit Grandma. One day, his mother put the beads on Peter, and they left for a ride to Grandma’s
house. When they turned left to go to Grandma’s instead of right to go shopping, Peter began to scream. His mother
was confused by the sudden outburst and immediately stopped the car. In the back seat, she found the child holding the
straw bag.

Quinn went to the mountains for a winter vacation with his family. His mother bought him a new red sweater for the
trip. Each day, he wore the sweater while happily playing in the snow. Three weeks later, his mother dressed him for
school in this red sweater, and he was so excited. He spent much of the school day anxiously looking out the window. By
evening, when his mother removed his sweater for bath time, he had a tantrum. He appeared to connect the red
sweater with playing in the snow, so he became upset when it did not snow on that particular “sweater day.”

Radzim’s favorite movie is about a young child getting a glass of warm milk before bed. He will watch the movie over
and over again. He especially likes the part when the mother in the movie says to the child drinking the milk, “Now,
now, not so fast.” Every night when he is ready for bed, he says, “Now, now, not so fast.” For him, the phrase “now,
now, not so fast” means something to drink before bed.

Steven has a large single-word vocabulary. He can list every character on Sesame Street, every geometric shape, and
every automobile make and model. Nonetheless, he is unable to name any attribute or action associated with these
things. He does not know how to ask for help or tell others when he is sick. His vocabulary is composed exclusively of
concrete objects.

Tai and her classmates were asked to place their hands in a “feeling bag” and describe how the objects in the bag felt.
When it was her turn, the teacher asked, “How does it feel?” Tai answered, “Happy? Mad? Calm? Frustrated?”
Although she was trying to identify emotions in herself and others, she did not understand that these terms do not apply
to inanimate objects.

Ugo was being taught different safety rules. One of the skills he learned was to telephone 911 for emergencies. His list
of emergencies included a stranger in the house when his parents were not home. One evening, he was with a
babysitter whose friend stopped by the house for a brief visit. Seeing the babysitter’s friend, he ran to the phone, dialed
911, and yelled, “Help—there is a stranger in the house and my mom and dad are not home.” To the embarrassment of
the babysitter, the police quickly arrived.

Visual Thinking Social and communication interactions require one to quickly attend to and understand
the meaning of fleeting visual and auditory information. The transient nature of language and nonverbal social
information can be difficult for people with autism to follow and, therefore, contributes to their social and
communication challenges. Individuals with autism may struggle to process the rapid progression of
interactions and events inherent in social interaction. They may have an easier time sustaining attention to
events that do not change and processing visual information that does not rapidly change (Grandin, 2009).
Research has found that visuospatial information is more easily processed than auditory and transient

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information in people with autism, who need more time to shift tasks when presented with auditory rather
than visual stimuli (Mostert-Kerckhoffs et al., 2015). In contrast to fleeting auditory information, visuospatial
stimuli (e.g., objects, pictures, graphics, written language) are fixed in space and time and therefore often are
easier for the individual to process. The amount of time the information remains fixed in space influences the
person’s ability to process. Visuospatial information can be attended to as long as needed for it to make sense,
whereas other inputs, particularly auditory ones, must be encoded instantly. Early studies indicate that people
with autism perform best on intelligence test tasks such as matching, block design, object assembly, and
pattern analysis (DeMyer, 1975; Harris, Handleman, & Burton, 1990; Lincoln, Courchesne, Kilman,
Elmasian, & Allen, 1988; Siegel, Minshew, & Goldstein, 1996), all of which involve stimuli that remain
visible at all times. More recent research, some of which involves brain imaging, also reveals visuospatial
processing strengths in individuals with autism (Jarrold, Gilchrist, & Bender, 2005; Mitchell & Ropar, 2004;
Pellicano, Maybery, Durkin, & Maley, 2006).
Temple Grandin is an adult with autism who has a doctoral degree and is a professor in animal science. In
her personal account of living with autism, Grandin (2009) termed the visual strengths characteristic of the
disorder as visual thinking, and she emphasized the need to rely on visual images for understanding. She states
that she thinks in pictures. For Grandin, visual thinking is playing different videos in her head. The following
vignettes illustrate visual thinking.

Vallyn has mastered many computer software programs. The computer screen displays one piece of visual information
at a time, and she can control the sequence and pace of the information. At the same time, she has difficulty following
simple directions from a teacher or her mother because this type of interacting requires her to process multiple visual and
auditory stimuli quickly.

Willy rarely follows directions. His teacher tested whether his inability to follow directions is due to poor language and
social comprehension or to noncompliance. She found that when he is given verbal directions alone or verbal directions
with gestures, he does not respond. However, when he is given verbal directions paired with a picture cue, he is
consistently compliant. Even fleeting gestural movements occur too rapidly for him to follow. He needs to look at the
picture cue for a few seconds in order to understand.

Memory Challenges Memory is the complex process of how information has been organized and stored
for use. Memory tasks vary from short term (e.g., immediate repetition) to long term (e.g., accessing from all
previously stored information), and it can require recognition (e.g., multiple choice) or recall (e.g., accessing
information without explicit cues). Information that is integrated in flexible, meaningful ways can also be
accessed and used in flexible, meaningful ways.
Rote memory and recognition abilities appear to remain intact in people with autism. Rote memory does
not require flexible integration of information, and recognition tasks provide explicit retrieval cues. The
capacity to learn and remember, however, worsens for people with autism as information becomes more
complex (Minshew & Goldstein, 2001). Challenges may occur if there is a large amount of information or if
the structure of the information is complex and requires flexible thinking.
Some people with autism experience learning as a series of single events not connected to other related
experiences or broader concepts. The result is rote learning and responding. Because individuals with ASD
may store information in a more restricted manner, it is not surprising that they often rely on fragmented,
learned patterns (i.e., “In situation A, I do this; in situation B, I say this”). Consider, for example, the adult
with autism who always buys his newspaper from the same newsstand each week. When he arrives at the
newsstand and the paper is sold out, he is at a loss for how to get a paper. Because people with autism
frequently learn and respond in this rote manner and do not generalize experiences, they are dependent on a
specific context or set of cues in the environment. Memory tasks that require free recall without explicit
retrieval cues can be problematic. Impaired recall memory is believed to contribute to social communication
challenges. People with autism are less able to access information that is relevant to the rapidly changing social
context and may rely more on concrete retrieval cues to remember language information (Tager-Flusberg &
Joseph, 2005b) and to initiate spontaneous communication. Over the years, Grandin has described her
gestalt-driven, visual memory strategies. In 1995, she stated,
To access spoken information that I have heard in the past, I replay a video of the person talking to me. To retrieve facts, I have to
read them off a visualized page of a book or replay the video of some previous event. This method of thinking is slow; it takes time to
play the videotape in my imagination” (p. 35)

In 2009, she stated,

“My mind works similar to an Internet search engine, set to locate photos. All my thoughts are in photo-realistic pictures, which flash

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 up on the computer monitor in my imagination. Words just narrate the picture” (p. 1437).

The following vignettes illustrate memory differences in children with autism.

Xavier excels at memorization. In geography class, he made a list of every mountain in the world and its exact height
as well as a list of every body of water in the world and its depth. He has also memorized the definitions of many of the
words in the dictionary, although he is unable to put any of the words into a sentence or paraphrase their meaning.

Nancy had “mastered” many tasks presented by her classroom teacher. Other therapists at school, however, were unable
to get her to complete similar tasks, and her parents did not observe these skills at home. Upon closer examination, it
became clear that her “mastery” was context specific, limited to specific materials and teacher cues. Lack of
generalization reflected lack of meaning.

Social Cognition
Social cognition is processing, interpreting, and understanding the social and emotional information conveyed
by others (Frith & Frith, 2012). Typically, humans have a predisposed sensitivity to the feelings of others.
Understanding these feelings results from being able to associate emotions with behaviors. This linkage starts
early, when typically developing infants socially reference or look for others’ reactions to physical and social
events. Through social referencing, people seek to understand the socioemotional significance of each
experience. Theory of mind is a concept that falls under the umbrella of social cognition, with the theory of
mindblindness explaining some of the challenges in this area (Baron-Cohen, Tager-Flusberg, & Cohen, 2000;
Tager-Flusberg & Joseph, 2005b). Another proposed theory for weaknesses in social cognition is termed
empathizing and systemizing (Baron-Cohen, 2009). Both theories address the fundamental challenges with
social understanding that characterize autism.
Theory of Mindblindness Theory of mind (ToM) references a person’s capacity to read the thoughts and
feelings of others and understand that other people have intentions, thoughts, desires, and feelings that differ
from his or her own (Baron-Cohen, Leslie, & Frith, 1985; Tager-Flusberg, 1996). In order to understand the
mind of another, it is necessary to 1) make sense of the inner mental states of self and others and understand
that others may have perspectives that differ from one’s own; and 2) predict from the thoughts, beliefs,
desires, and intentions of others what they are going to do next. It is about recognizing, understanding, and
predicting the mental states of others.
Over time, young children develop ToM. This ability to infer mental states allows a person to anticipate,
comprehend, and predict the social behaviors of others (i.e., “I know what you know”). In other words, it is
necessary for an individual to make sense of another person’s behavior (e.g., she is looking up to see
something), imagine mental states (e.g., she sees something of interest), and predict what he or she might do
next (e.g., she is going to share her interest with me). An analogy used to explain ToM is the expression “put
oneself into someone else’s shoes” (i.e., to imagine another’s thoughts and feelings).
Theory of mind plays a significant role in social communication interactions (Frith, 2001; Happé, 2003).
For instance, in conversation a person will need to continually monitor what the partner knows and expects in
order to make his or her response relevant. Similarly, an individual interprets meaning and intent from the
verbal and nonverbal behaviors of the partner. Only with this social knowledge can a person regulate and
adjust his or her own language and social behavior in social-communicative interactions. The psychological
theory of mindblindness is proposed to explain the social and communication difficulties in autism, including
the pragmatic challenges in language (Tager-Flusberg, 2007). Pragmatic language challenges are difficulties in
effectively using and adjusting verbal and nonverbal messages for a variety of purposes with an array of
partners within social contexts (Jarrold, Butler, Cottington, & Jimenez, 2000).
Numerous studies conducted by researchers, including Simon Baron-Cohen and Uta Frith, have
investigated the degree to which people with autism have difficulty attributing mental states—such as intents,
thoughts, and feelings—to themselves and others in order to understand social behavior. Particular deficits
and delays in the development of ToM have been identified in people with autism. With ToM delays or
deficits, people with autism fail to describe, explain, or infer mental states during social situations, and they
have difficulty comprehending nonliteral language.
A seminal study examined ToM challenges by testing children’s ability to understand different types of
social events using a multipicture sequencing task (Baron-Cohen et al., 1985). Three types of sequenced
stories were presented: physical-causal (e.g., a child smiling while swinging on a swing), social-behavioral
(e.g., a child crying after someone took his ice cream out of his hand), and mental state (e.g., a child looking
confused after someone took his toy when he was not looking). They compared the performance of children
with intellectual disabilities and typically developing children with the performance of children of a higher

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mental age who had autism. In contrast to the children in the control groups, who had no problems with the
various story sequences, the children with autism understood the physical-causal and social-behavioral
sequences but had significant difficulty understanding the mental state sequences. Although all of the stories
entailed similar social and emotional content, the children with autism struggled only with social events that
required them to take into account what someone else knows or expects in order to predict his or her behavior.
Even when people with autism have been successfully taught ToM tasks, they can fail to generalize the
concept to new tasks presented in a different format (Baron-Cohen et al., 2000). Research has demonstrated
that language abilities in a person with autism are related to the acquisition of ToM—individuals with more
advanced language skills demonstrate greater success with social cognitive tasks, verbal cognition, and flexible
conversational skills (Tager-Flusberg & Joseph, 2005a, 2005b).
People with autism have been found to be able to answer questions regarding mental states when tasks are
simplified in terms of processing requirements. The number of social cues can influence an individual’s ability
to interpret social situations. In an early study, children were shown videos of social scenes that varied the
number of cues leading to the correct understanding of the story (Pierce, Glad, & Schreibman, 1997). Each
short scene depicted a social interaction between two children in which an observable action occurred, such as
giving a gift. The four types of social cues presented in the scene were verbal (e.g., “I like your toy”), tone of
voice (e.g., speaking in an animated voice), nonverbal (e.g., smiling at a person), and nonverbal with an object
(e.g., giving someone a present). Children were asked a series of questions to assess their understanding of the
social situation. When compared with control groups, children with autism performed equally well on
questions relating to stories containing one cue. When stories contained multiple social cues for the correct
interpretation of the story, however, the children with autism performed poorly compared to the control
groups. The researchers concluded that the complexity of the social environment and the number of social
cues that individuals must simultaneously attend to strongly influence their ability to interpret the meaning of
a social situation. When people with autism must simultaneously process multiple social cues within a rapidly
changing environment, the attentional and processing demands can be too challenging.
Empathizing and Systemizing Related to ToM, an empathizing and systemizing theory has been
introduced to explain the social and communication difficulties in autism as well as nonsocial features such as
narrow interests, need for sameness, and attention to detail. This proposed theory references delays and
deficits in empathy in contrast to stronger abilities for systemizing (Baron-Cohen, 2009).
Empathizing involves recognizing the emotion that accompanies a person’s mental state and having an
appropriate emotional reaction to those thoughts and feelings. Systemizing is the drive to analyze or construct
systems that follow rules. When we systemize, we are trying to identify the rules that govern the system in
order to predict how that system will behave. People with autism may excel at static events such as
understanding rules and systems (systemizing) and struggle at understanding dynamic or evolving events
(empathizing) (Baron-Cohen, 2009). With a focus on systemizing, they may engage in repetitive behavior to
communicate the need for sameness and express a resistance to change.
Social Misunderstanding Social understanding begins with social interest, shared attention, and social
communicative and emotional reciprocity. These skills lay the foundation for social learning. The
development of social understanding requires cognitive flexibility. Social concepts are formed when
individuals compare their perceptions, experiences, thoughts, and feelings with others’ during shared social
experiences. In people with autism, social concepts are driven by concrete, perceptual information. This limits
the development of inferential reasoning, which is required for understanding abstract social concepts and
developing social perspective-taking. The result is limited social understanding and, in turn, self-directed
social and communication behaviors that do not take into account the perspective of others.

Figure 1.2 depicts four social messages. The two messages on the left are physical, and their meaning is
derived from observable social behaviors. The two on the right, although physical in nature, require an
understanding of internal mental states to infer the meaning. People with autism are more likely to
understand the messages shown on the left because the meanings are linked to observable events. In contrast,
they are more likely to be challenged by the messages on the right, which require ToM for comprehension.

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Figure 1.2. Theory of mind display. (The Picture Communication Symbols © 1981–2015 by Mayer-Johnson LLC a Tobii Dynavox
company. All Rights Reserved Worldwide. Used with permission.)

The following vignettes illustrate struggles with social cognition in children with autism.

Abdul was striving to understand the meaning of mental state terms such as “think” or “know.” In one instance, he was
working with his teacher on story sequencing. They were looking at a picture of a girl holding a pencil near her face
and thinking about a drawing that she was preparing to begin. His teacher asked, “What is the little girl doing?”
“Thinking,” he replied. “What is she thinking about?” his teacher asked. “She’s thinking at her desk,” he said. His
teacher asked the same question again, this time emphasizing the words “what” and “about.” He answered, “She’s
thinking at her desk with a pencil on her head and paper on her desk.” He did not understand that others have
“thoughts” that influence their observable actions and was unfamiliar with the phrase “think about,” so he struggled to
understand the meaning of his teacher’s question.

Brandon was participating in a group activity with his class. During the lesson, the teacher accidentally tripped over a
building block and fell to her knees. The other children expressed concern while he laughed. Most of the children cleaned
up the materials after the lesson, but he arranged the building blocks exactly as they were when his teacher fell. Then he
reenacted his teacher’s falling over the block three times. The first and second times, he laughed. The third time,
however, he rubbed his knee because it hurt. He then walked over to his teacher, rubbed her knee, and asked, “Okay?”
He needed to experience the physical pain in order to understand the situation and express empathy.

Collin had been learning about his and others’ feelings. His teacher was helping him to “see” what people are doing
when they feel ________, how they look when they feel ________, and what to say when they feel ________. He
was becoming increasingly able to identify feelings observed in his family and friends and to comment on these feelings.
Everyone was very excited about his growing social awareness. Then one day, he asked his teacher, “Can I look in the
mirror to see how I am feeling?” The true meaning behind expressions of feelings continued to elude him.

Without social perspective-taking, people with autism find it difficult to predict the behavior of others and
therefore seek social interactions that are predictable. Lacking an understanding of social concepts such as
others’ mental states, they can find it difficult to monitor, predict, and adjust to ongoing social and
communication interactions.

SUMMARY
Although there have been significant gains in understanding the nature of autism, no singular explanation has
yet been found for the disorder. New theories continue to emerge with regard to etiology and intervention.
Investigations into the development of shared attention, ToM, and socioemotional reciprocity provide

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insights into autism, but questions remain about how these aspects of development interface with other
characteristics of autism, such as ritualistic behaviors, sensory sensitivities, and anxiety. Current theories
continue to dissect isolated skill impairments without a clear understanding of their interdependence. The
notion of one “theory” of autism—that is, a singular explanation for the multitude of learning and behavior
challenges associated with the disorder—is highly unlikely. Rather, each proposed theory is an important
piece of the puzzle that is ASD, reminding us to appreciate the complexity of autism and the diversity of the
spectrum.
Research shows that people with autism experience the world and develop differently from typically
developing individuals, specifically with regard to communication, social interaction, and socioemotional
development. The inability to process and understand social and affective information in a cohesive manner
may lie at the core of autism. As a result of viewing the social world from a unique perspective, people with
autism struggle to understand messages, comprehend social perspectives, interpret emotion, and integrate
information meaningfully. Those with autism have difficulty deciphering the complexity of social
relationships, making reciprocal social and communication interactions challenging. Their challenges with
interpreting the social behaviors and emotions of others can contribute to social isolation and frustration. As a
means to cope with the “social chaos,” people with autism may become intensely preoccupied with small
details and seek a high level of predictability in the physical world. These coping mechanisms may be
externalized as ritualistic, repetitive behavior that at times brings meaning and comfort and at other times
expresses uncertainty and anxiety.
Professionals and parents need to understand the communication patterns, social perspectives,
socioemotional qualities, and thinking patterns characteristic of autism, as well as the child’s unique strengths
and needs, in order to guide selection of effective intervention strategies and maximize development.
Awareness, understanding, and compassion should guide intervention planning, with a respect for the
complex challenges at the heart of ASD.

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 CHAPTER 2

Understanding Social and Communication

Development and Challenges

LEARNING GOALS:
1. Describe the typical development of core nonverbal social–communication skills and identify associated
challenges related to autism spectrum disorder.
2. Describe the typical development of social skills and identify associated challenges related to autism
spectrum disorder.
3. Describe the typical development of communication skills and identify associated challenges related to
autism spectrum disorder.
4. Describe the restricted, repetitive behaviors related to autism spectrum disorder.

S ocial interaction and social–communication challenges are central to autism. As such, knowledge of the
critical stages of typical social and communication development is essential to understanding and
identifying characteristics of autism spectrum disorder (ASD), conducting assessments, writing goals
and objectives, planning intervention, selecting instructional strategies, implementing best practices, and
monitoring ongoing progress. This chapter provides an introduction to typical and atypical development in
the following areas:
• Core skills for social and communication development
• Social skills development
• Communication skills development
This chapter also briefly introduces the other primary characteristic of autism, engagement in restricted
and repetitive behaviors.

CORE SKILLS FOR SOCIAL AND COMMUNICATION

DEVELOPMENT
Developmental milestones are a set of observable functional skills, behaviors, or abilities that most children
acquire at a certain age. Children reach milestones in how they learn (cognitive), interact (social and
emotional), and speak (language and communication). The emergence of core developmental milestones lays
the foundation for socialization and communication outcomes (Kover, Edmunds, & Weismer, 2016). For
example, a child must be able to share his or her attention with others while interacting and imitate what
others are doing and saying in order to develop social and communicative (i.e., related to conveyance or
exchange of information) competence. Figure 2.1 illustrates the core skills needed for social and
communication development.

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Figure 2.1. Core skills needed for social and communication development.

Nonverbal social-communication and imitation skills develop quickly and naturally in typically developing
children during the first years of life. Table 2.1 provides examples of some of the early social and
communication developmental milestones. For comprehensive ages and stages at which children are expected
to reach developmental milestones, see growth charts with timetables published by organizations such as the
American Academy of Pediatrics (AAP), the American Speech-Language-Hearing Association (ASHA), and
the Centers for Disease Control and Prevention (CDC).

Table 2.1. Early developmental milestones (3–24 months of age)

Age (months) Core skills
3–6 Shares social smiles
Demonstrates shared attention
Imitates some movements and facial expressions (e.g., smile, frown)
Imitates sounds
6–12 Establishes joint attention
Responds to own name
Plays simple games with others (e.g., Peekaboo)
Combines gestures
Points to items of interest
Pulls others to gain attention
Uses simple gestures (e.g., gives, shakes head, reaches, raises arms, shows, waves, opens hand, taps)
Responds to and imitates emotions from facial expressions
Imitates novel actions
Imitates single-syllable sounds (e.g., “ma,” “ba”)
Demonstrates interest in cause-and-effect toys
12–18 Shows interest in peers
Responds to adults’ emotions
Combines gestures, eye gaze, and words (e.g., claps, blows a kiss, nods head, thumbs up, symbolic gestures such as high five)
Points (i.e., with index finger) to reference and show things of interest
Imitates two-syllable words (e.g., mama, uh-oh)
Imitates adult actions to solve a problem
Explores combining toys in novel ways
Engages in repetitive play sequences with toys (e.g., feeding a doll)
18–24 Shows pleasure in accomplishments
Comforts others
Engages in interactive play with adults
Communicates needs, interests, and feelings
Plays parallel (e.g., next to) peers
Begins to imitate peers
Begins symbolic toy use

Source: Centers for Disease Control and Prevention (n.d.).

The developmental process begins with the acquisition of nonverbal means to interact with others (e.g.,
gestures, reciprocal interactions) and imitation (e.g., motor, verbal). These early years, the time period
between birth and when a child begins to use words or signs meaningfully, are referred to as the prelinguistic
stage (Crais & Ogletree, 2016). This is when children learn conventional shared meanings for both nonverbal
symbols (e.g., gestures, facial expressions, tone, volume) and verbal symbols (e.g., words). This stage is evident
through the early use of gestures (i.e., movement of a part of the body to express an idea or meaning, such as
waving and pointing) and imitation (i.e., observe and replicate another’s behavior), which quickly develops
into the use of language to interact with others (e.g., verbal imitation, combining gestures and words,
reciprocal verbal exchanges). During the early years, children also develop the ability to imitate a growing
number of related activities (e.g., imitate a series of related actions or words, engage in a sequence of actions or
repeat a sequence of spoken words). For foundational information on social and communication development,
see Bates (1976), Bloom (1993), Brazelton (1994), Eimas (1996), Garvey (1977), Kagan (1994), Rubin
(1980), and Wells (1981).
The emergence of core social and communication skills is influenced by early emerging temperament (i.e.,
basic dispositions that underlie and modulate the expression of emotions, motor activity, attention, and self-
regulation), inherent social motivation, and exploration of the social environment (Adamek et al., 2011;
Conture, Kelly, & Walden, 2013; Smith et al., 2010). A child’s comfort level, activity level, and reaction to
physical and social stimuli contribute to his or her social motivation and social exploration. When the child is
motivated to explore the physical and social environments, he or she develops a growing understanding of how
to socialize and communicate with others.
To understand this developmental process, it is essential to view the child within the context of social
interaction. The adult–child dyad is the focus of social interactions during the first years of life. In these early
years, the adult continually adjusts to the behavioral style of the child, and the child adjusts to the interaction
style of the caregiver (Yoder & Warren, 2001). The child’s ability to understand the context and people in his

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or her environment contributes to the development of core social and communication skills.
It is important to note that adults and children from all cultures jointly structure their interaction in a way
that reflects differing sociocultural and gender characteristics and values. Cultural variances can result in
differences in how nonverbal (e.g., maintaining eye gaze, directing attention, using nonverbal cues and
gestures, sharing affect), communication, and social skills (e.g., play) present and develop in children (Douglas
& Stirling, 2016; Dyches, Wilder, Sudweeks, Obiakor, & Algozzine, 2004; Trembath, Balandin, & Rossi,
2005). For example, a child from a culture in which children are taught to not make direct eye contact with
adults as a sign of respect might have a lack of eye contact noted as a deficit on an assessment. To provide an
understanding of autism, the next sections include an overview of typical development and the atypical
challenges associated with autism in the core skills of nonverbal social–communication and imitation.

Nonverbal Social–Communication: Typical Development

Nonverbal social–communicative interactions are important milestones in the development of cognitive,
social, and communication skills. During the first year of life, infants are not yet producing words, but they do
acquire the ability to use and respond to nonverbal eye gaze, gestures, and facial expressions in social
interactions (Tager-Flusberg et al., 2009b). During this preverbal communication phase, young children
develop nonverbal social–communication skills to make basic requests, initiate social interactions, engage in
reciprocal turn taking, and share interests with others. Children also nonverbally respond to social initiations,
requests, and comments of others. The development of these behaviors is marked by the increasing capacity
for social turn taking and the ability to coordinate the use of eye gaze with gestures. To learn to be an active
social partner and communicate using words, young children acquire the ability to share intent, affect, and
attention during their first years. These early nonverbal social–communicative interactions can be classified as
behavioral regulation skills, reciprocal social interaction skills, and coordinated joint attention skills (Quill,
2000; Shumway & Wetherby, 2009).
Regulation Behavioral regulation skills are nonverbal social–communicative interactions used to regulate
another person for the purpose of expressing intent. An important aspect of nonverbal interaction is the
intentionality of the individual (Franco, Davis, & Davis, 2013). Intentionality is an awareness of the effect that
a communicative behavior will have on others and the ability to persist in that behavior until the desired effect
is obtained (Tomasello & Carpenter, 2007). Children acquire a repertoire of conventional gestures and sounds
to express intentions before using words. The development of social interaction begins when adults infer
intentionality from a child’s nonverbal behaviors. Young children begin to “regulate” others to communicate
requests and get needs met (McClelland et al., 2007). For example, a child may make a request by pulling an
adult toward something, vocalizing a sound, and reaching or pointing toward the desired item.
Intentionality on the child’s part is observed when he or she directs nonverbal behaviors toward others.
Examples include when a child reaches for an adult’s hand to be tickled or the child protests by pushing an
object or person away. By 12 months, a child generally uses simple gestures, like shaking the head “no” or
waving “bye.” When a child shares gestures, sounds, or other behaviors to deliberately achieve a goal, he or she
is intentionally communicating.
These early intentional gestures and sounds are critical because they demonstrate the child’s growing
knowledge of shared meaning and are the foundation for the development of communication. These
intentional behaviors are used to influence the responses of others to meet one’s needs (i.e., regulation) and
contribute to an individual’s ability to sustain interaction with others (i.e., reciprocal interaction) and share
interests (i.e., shared attention).
Reciprocity Reciprocity is the use of nonverbal social–communication skills to initiate and/or maintain
turn-taking interactions with another person. A child who displays social reciprocity pays attention to the
emotional cues of others, interprets those cues, responds to what he or she interprets, and engages in social
interactions with others (Constantino et al., 2003; Leach & LaRocque, 2011). Reciprocal social interaction
skills include behaviors such as eye gaze, gestures, facial expressions, simple actions, or vocalizations. Early
reciprocal interactions include smiling, waving “bye-bye,” and reaching to be picked up. These nonverbal
reciprocal interactions—exchanging eye gaze, gestures, and facial expressions—begin to develop during
infancy and lay the foundation for social and communication development.
With reciprocal interaction, the child and social partner have a back-and-forth dialogue by taking turns
initiating or responding to nonverbal communicative messages grounded in a shared focus of attention. The
use of eye gaze plays an important role in social interactions because it signals attention and social interest in
another. Typically, by age 9–12 months, children can play turn-taking games such as Peekaboo. During these
turn-taking interactions, individuals share affect and emotions.

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 Attention Joint attention skills are coordinated nonverbal social–communicative interactions used to
share attention with another person (Bruinsma, Koegel, & Koegel, 2004). Joint attention is the set of skills
two individuals use to jointly attend to or communicate about a third entity such as an object or event. These
skills include 1) responding to another’s cues by following the person’s visual line of eye gaze (attention)
and/or gesture such as pointing, 2) coordinating eye gaze and gestures with the other person, and 3) using eye
gaze and/or gestures to direct the other person’s attention to events or objects (Meindl & Cannella-Malone,
2011). Simply stated, joint attention is a three-point exchange that consists of coordinating attention among
oneself, another person, and an event or object.
At a basic level, joint attention involves eye-gaze shifting (i.e., alternating one’s eye gaze between a person
and the object or event) and can involve gesturing (e.g., pointing toward an object or event). Typically, by age
9 months, children can use fingers to point at things. By 18 months, children can generally point to show
others something interesting. In typical development, between the ages of 8 and 15 months, initiating or
responding to joint attention bids appears. Joint attention is important to the development of language and
social skills competence.
Although joint attention can look similar to behavioral regulation, the function of joint attention is
different. During a joint attention interaction, two people share attention and affect around a social experience
focused on an event or object. When a child engages in joint attention, it signals that he or she wants to
engage in a social–communicative act. Following or responding to eye gaze and gestures in joint attention
forms the basis for an individual’s ability to figure out the other person. Thus, coordinated joint attention is a
social and learning experience. Through participation in joint attention activities, children learn that people
have distinct thoughts that can be shared through communication. This understanding requires a capacity for
symbol use or shared meanings for gestures, facial expressions, and later language (Watt, Wetherby, &
Shumway, 2006). Symbol use is understanding that gestures, expressions, and language stands for or suggests
something, and we learn these relationships or associations through our social interactions with others
(Goodwyn, Acredolo, & Brown, 2000).
Joint attention links language with shared experiences (Murray et al., 2008). When a child engages in joint
attention, he or she can elicit language input from the other person; thus, joint attention can facilitate
receptive and expressive language development (Yoder, 2008). During joint attention activities, people share
affect and display emotions (e.g., pleasure or displeasure), directing eye gaze to another to share an experience.
This is how children learn to interpret emotional states of others as they respond to experiences of facial
expressions. Through the social orienting involved with joint attention, children learn the meaning of
emotions.
Behavioral regulation, reciprocity, and joint attention all contribute to effective nonverbal social–
communicative interaction. The following vignette illustrates the core skills of one typically developing child.

It is Devon’s first birthday party. He sits in his high chair, surrounded by his family, and watches everyone’s reactions
when the birthday cake appears. Devon looks at his father, vocalizes (makes a sound) to get his father’s attention, and
then points to the cake. He continuously shifts his focus (eye gaze) from the cake to everyone singing “Happy Birthday.”
He smiles and rocks his head back and forth to the singing. He then claps when everyone else claps at the end of the
song. Devon watches as his mother pretends to blow out the candles, and he imitates her. Devon and his mother blow
out the candles together. He claps again, raises his arms in the air, and looks at everyone in an effort to get attention.
He smiles as everyone says “hooray!”

In a few brief moments, the child in the scenario demonstrated all the core skills that are the foundation of
social and communication development. The following section will provide insight and understanding into
challenges with these core skills in ASD.

Nonverbal Social–Communication: Autism Spectrum Disorder

Social-communicative interactions are unpredictable and dynamic (i.e., evolving and changing) activities that
require integrating contextual, social, and communication information. Research into the origins of
developmental disabilities has shown that cognitive, social, and communication differences interface in
complex ways in people with autism. For foundational information on social and communication differences
in children with autism, see Charman (1997), Lord and Paul (1997), Prizant (1996), Tager-Flusberg (1996),
Quill (1995), Wetherby (1986), and Wolfberg (1999). The learning patterns of autism do not align with the
requirements of social–communicative interaction. As indicated in Table 2.2, the basic learning patterns of
people with autism contrast sharply with social–communicative demands.

Table 2.2. Autism spectrum disorder learning patterns versus social–communication requirements

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Autism spectrum disorder learning style pattern Social–communication requirements
Repetitive Flexible
Organized and static Dynamic
Predictable Random
Visual Multisensory
Concrete Social

The following vignette illustrates the discrepancy between the learning styles associated with autism and
the demands of social–communicative interaction.

Edgar likes numbers. If given the choice, he would write or recite numbers all day. At his school team’s initial meeting,
his teacher brought a copy of his handwritten number chart (from 1 to 500 in precise columns and rows). His teacher
reports that he successfully completes academic worksheets but will not participate in group discussions. She also has
observed that he plays alone without other children. Through a discussion of his activity preferences, the team begins to
understand the paradox between his learning strengths and social struggles and why interaction with peers is hard for
him. This understanding helps the team make decisions about appropriate support for Edgar.

In this scenario, the child with autism focuses on information that makes sense to him and disregards
social activities that do not. His number chart and counting is a static (i.e., unchanging), predictable,
repetitive, visual, and concrete activity that allows for sustained and focused attention. His interest in that
particular item is, in many ways, representative of the learning style of many with autism. Numbers, by their
very nature, are patterned, sequential, and infinitely orderly. Special interests such as numbers, letters, books,
computers, trains, presidents, and videos are commonly observed in people with autism. In contrast, typical
social and communicative interactions are unpredictable, dynamic, and random; they are multisensory
experiences that require flexibility and social understanding. An appreciation of this sharp contrast is useful in
understanding social challenges in autism and in developing instructional adaptations that are necessary for
promoting social growth.
There are differences in many areas of nonverbal social–communicative interaction for people with autism
compared with typically developing individuals (Chiang, Soong, Lin, & Rogers, 2008). DSM-5 (APA, 2013)
provides illustrative, but not exhaustive, examples of nonverbal social–communication and social interaction
challenges experienced by people with ASD. These include
• Difficulties with socioemotional reciprocity. Challenges could include a failure to initiate or respond to
social interactions or an atypical way of approaching and interacting with others. People with autism may
not engage in typical back-and-forth conversation, and there may be minimal sharing of interests, feelings,
and affect.
• Challenges in using nonverbal communicative behaviors when socially interacting. The challenges might
include difficulty combining and integrating verbal and nonverbal means of communication, poor or
atypical body language and eye contact, difficulty using or understanding gestures, or a complete lack of
nonverbal communication or facial expressions.
• Challenges with relationships. Children with autism may have difficulty understanding, developing, and
maintaining relationships with others and show a lack of interest in peers. They may have difficulty
making friends and engaging in play with other children, particularly imaginative play. They also may have
trouble adjusting their behavior appropriately based on the social context.
The nonverbal social–communication skills in people with autism are characterized by a range of difficulty
with behavioral regulation skills, reciprocal interaction skills, and joint attention skills, and these difficulties
result in impaired social reciprocity (Quill, 2000; Wetherby, 2006). Skills and abilities in people with autism
can vary significantly, but social reciprocity challenges are generally evident in individuals across the spectrum.
Regulation Behavioral regulation skills, or the nonverbal social–communicative interactions used to
regulate another person for the purpose of expressing intent (Tomasello, Carpenter, Call, Behne, & Moll,
2005), can be challenging for people with autism. People with autism may not demonstrate intentionality as
typically expected, and their style of interaction may be expressed in unconventional ways (Maljaars, Noens,
Jansen, Scholte, & van Berckelaer-Onnes, 2011). For example, children with autism may use various gestures
to make requests, and may acquire the ability to respond to others, but self-initiated commenting and
demonstrating coordinated attention may be specifically challenging (Travis & Sigman, 2001).
It is not that children with autism do not communicate intent but rather that they may not readily
communicate for social purposes. Children with ASD may communicate predominantly or exclusively to
regulate the behavior of others (e.g., requesting something, protesting something, attempting to get their
needs met) rather than to share a social experience (Wetherby, Prizant, & Schuler, 2000). For example, eye

37
gaze and gestures may be observed when a child is being tickled, but these behaviors are less likely to be
observed when he or she is required to reciprocate by tickling the other person. This pattern of
communication is not a characteristic of children with specific language or general developmental delays. The
following vignette demonstrates unconventional means of communicating intent in a child with autism.

Frankie was taught that the acceptable way to get someone’s attention was to tap an individual on the wrist.
Consequently, he awakened his mother one night at 3:00 a.m. by pulling off the bed covers in search of her wrist. Once
he found her wrist, he tapped it. It turned out that he had a high fever. The means he used to initiate intent or social
interaction, even when ill, was always done in precisely the same way. Frankie did not have a diverse means of
communicating with others and did not vary his style of interaction in new contexts or situations.

Reciprocity Reciprocal social interaction skills, or the nonverbal social–communicative interactions used
to initiate or maintain turn-taking routines with another person, can be another area of difficulty for people
with autism (van Ommeren, Begeer, Scheeren, & Koot, 2012). For example, they may engage in briefer turn-
taking sequences and respond less frequently to the initiations of others during social interactions.
Children with autism may make requests for objects, actions, and social routines but have difficulty
initiating and sharing an awareness of an object or event with another person. Interaction may be challenging
for children with autism due to their restricted learning patterns and difficulty maintaining the natural pace of
social encounters. In the absence of understanding the process of reciprocal interactions, children with autism
may interact in atypical ways or demonstrate shared attention in more limited contexts. As children with
autism acquire effective means to interact with others, they are more socially motivated to maintain their
success. The following vignette illustrates limited social reciprocity in a child with autism.

Gino laughs aloud whenever his parents tickle him or swing him in the air. He looks at them the whole time they play
these social games to indicate that he wants to continue playing. He uses eye gaze to sustain many activities that are
pleasurable and meaningful. He does not, however, understand that he can also use eye gaze to share interests with his
parents.

Attention Joint attention skills, or the coordinated nonverbal social–communicative interactions used to
share attention with another person, are another challenge area in autism (Bono, Daley, & Sigman, 2004;
Mundy & Newell, 2007; Yoder & McDuffie, 2006). Attention and orienting processes can be affected by the
individual’s level of comfort with sensory stimulation (Donkers et al., 2015). For example, auditory filtering
difficulties have been associated with differences in attention in children with ASD (Sanz-Cervera, Pastor-
Ceezuela, Fernández-Andrés, & Tarraga-Minguez, 2015). Personal accounts by adults with autism (e.g.,
Temple Grandin) have suggested that people with ASD experience atypical responses to environmental and
social stimuli. Unusual sensitivities to visuals, sounds, smells, taste, touch, and movement can reduce the
individual’s ability to respond to and be comfortable with social interactions.
A lack of joint attention skills has been described as an early warning sign, and these deficits can be strong,
distinct indicators that differentiate young children with autism from children with other developmental
disorders (Adamson, Bakeman, Deckner, & Romski, 2009). Joint attention can be an area of challenge in
individuals with autism regardless of age and developmental or intellectual level.
People with autism may display challenges with eye-gaze shifting, difficulty with gestural joint attention,
and fewer responses to joint attention bids (Mundy & Thorp, 2006). They may infrequently or rarely alternate
eye gaze between an interesting object and another person, show objects, or point to objects for the purpose of
sharing their interest (Whalen, Schreibman, & Ingersoll, 2006). Even when an individual with autism is able
to coordinate eye gaze, gestural communication, and turn taking, the skills for monitoring and sharing joint
interests in an object or event may be lacking. People with autism can experience challenges responding to
others (e.g., looking in the direction where another person is pointing), initiating joint attention (e.g.,
showing, pointing), and specifically using joint attention for indicating and commenting (Jones, Carr, &
Feeley, 2006).
Although the challenges are typically more severe for initiation of joint attention, people with autism can
have challenges in responding to joint attention as well (Clifford & Dissayanake, 2008). When a child does
not respond to initiated joint attention, he or she misses a number of naturally occurring opportunities to
develop skills (Schietecatte, Roevers, & Warreyn, 2012). When a person experiences difficulty with joint
attention skills, he or she might not be aware that others are interested in what that person perceives.
In autism, a lack of joint attention skills may be connected to difficulty regulating, understanding, and
relating to the emotional cues of others (Krstovska-Guerrero & Jones, 2016). Being unable to perceive and
understand emotional expression can limit the capacity to share attention and emotion with others. It also

38
explains poor social attention, limited social interactions, trouble inferring mental states (e.g., feelings,
thoughts, intentions), and difficulty with social reciprocity. Impaired joint attention contributes to the atypical
development of reciprocal communication and pretend play (Rutherford, Young, Hepburn, & Rogers, 2007).
Recall the social behaviors that Devon, the typically developing child, displayed at his birthday. In
contrast, the following vignette describes Henrich, a child with autism, also experiencing his first birthday
party.

Henrich sits in his high chair, surrounded by his family, and flicks his fingers in front of his eyes. His mother moves his
hands to his side so she can present the birthday cake. His father calls his son’s name in an attempt to get his attention
to take a photograph. He does not look up, and the father further attempts to get his young son’s attention by pointing
to the cake. While everyone is singing “Happy Birthday,” Henrich flicks his fingers in front of his face. He looks up
when everyone shouts “Hooray!” but does not make eye contact with anyone in particular. Everyone claps at the end of
the song. His mother models and pretends to blow out the candle in an attempt to get her son to imitate. Finally,
Henrich’s brother is allowed to blow out the candle. Henrich expresses no emotion or excitement at his own birthday
party and displays particular challenges with joint attention.

Even when children with autism demonstrate nonverbal social–communicative behaviors such as eye gaze
and gestures, they may have a reduced understanding of the various social functions served by behaviors.
Qualitative, not quantitative, measures of eye gaze, gestures, and other nonverbal social–communicative
behaviors in autism reveal the nature of the impairment. This is an important point to note. If an evaluator
was using an assessment that asked whether a particular skill was or was not present, the item might be scored
as present if the child displayed the skill. However, the assessment might miss limitations or differences in
how the skill was being used. For example, the assessment might not reveal that the nonverbal social–
communicative behavior serves a limited number of functions. The child might point to request and get an
item, but not point to show and share an item. Pointing to get an item is about having a need met and is
strictly about the individual. Pointing to show an item is about sharing an experience and involves another
individual.

Imitation: Typical Development

Imitation is the act of using someone as a model and copying his or her behaviors. Imitation is a social
behavior with different functions that depend on the context and/or the partner (Anderson et al., 2009). It is
an important milestone in the development of cognitive, social, and communication skills. Imitation skills
contribute to a child’s growing understanding of the physical world. The ability to imitate gross motor (large
muscle groups) movements, fine motor (smaller muscle groups) movements, oral-motor (face and oral
muscles) movements, and actions with objects is necessary for learning social and communication skills.
Imitation plays a critical role in the emergence of symbolic play and the development of symbolic thought
(Piaget, 1962).
Imitation helps children understand the relationship between themselves and others in terms of shared
physical, social, and emotional experiences. It enhances self-awareness and provides a sense of shared
experiences (Vygotsky, 1964), which contributes to social relationships. Imitation is necessary for sustaining
social interactions (Rogers & Williams, 2006). Before words, through the imitation of new behaviors, children
acquire a repertoire of conventional sounds and gestures to express intentions.
According to developmental theory, infants at an early stage of imitation first show an emergent interest
and motor responses when adults imitate their behaviors. The motivation to continue an interaction sustains
the imitation exchanges. Typically, by age 4 months, children can copy some movements and facial
expressions like smiling or frowning. Between ages 6 and 9 months, young children can immediately imitate.
By 6 months, children can generally respond to sounds by making sounds. By age 9 months, children can
typically copy sounds and gestures of others.
During the first year of life, children progress from repeating motor and vocal actions within their
repertoire to imitating novel actions. By 1 year of age, children imitate social acts such as waving “bye-bye”
and object use such as drinking from an empty cup. Between ages 12 and 24 months, children develop the
capacity to symbolize or make one thing stand for or represent something else (e.g., a stick is a sword). By age
2, children can imitate a sequence of novel actions, they can imitate invisible acts (i.e., actions they cannot see
themselves doing), and they can engage in deferred imitation (i.e., repeat actions they observed in others at an
earlier time).

Imitation: Autism Spectrum Disorder

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In autism, imitation challenges are hypothesized to be connected with the earliest developmental stages, with
early disruptions in imitation affecting cognition and learning (Ingersoll & Lalonde, 2010). Imitation delays
can negatively affect quality of life and are correlated with restricted levels of social relatedness, reciprocity,
play, and language (Hepburn & Stone, 2006). Imitation challenges can have a cascading effect in children
with autism (Poon, Watson, Baranek, & Poe, 2012). For example, interference with play or prosocial
interaction can in turn affect language development (Toth, Munson, Meltzoff, & Dawson, 2006). People with
autism vary significantly in their ability to imitate what others do and have been found to imitate less than
other populations (Rogers, Young, Cook, Giolzetti, & Ozonoff, 2010).
A variety of studies have provided insight into some of the difficulties that people with autism have with
imitation, and there are numerous theories proposed for why they experience imitation challenges (Williams,
Whiten, & Singh, 2004). One explanation is that imitation challenges are social in nature (Cook & Bird,
2012). With this explanation, imitation challenges are associated with difficulties with joint attention and
socioemotional understanding and processing (Ingersoll, 2012). When people with autism do imitate
demonstrated actions, they have been found to be less focused on faces and thus may not receive all of the
social information that provides meaning to the action (Vivanti, Trembath, & Dissanayake, 2014). The ability
to imitate what others do while not understanding the meaning of those actions distinguishes people with
autism from other populations of similar developmental levels.
People with autism may have trouble imitating gestures that lack meaning to them as opposed to imitating
meaningful actions (Vanvuchelen, Roeyers, & De Weerdt, 2007). Research on eye tracking has found that
individuals with autism direct gaze downward toward objects with meaningful actions, whereas they direct
eyes ahead with nonmeaningful gestures (Vivanti, Nadig, Ozonoff, & Rogers, 2008). People with autism also
experience reversal errors, illustrating that they may have challenges translating the perspective of what
another person sees (Shield & Meier, 2012). For example, in imitating the action of holding hands up, palm
away, people with autism may hold their palms toward themselves, recreating their own view.
Another explanation for imitation challenges is that they are due to difficulties with attention. With this
explanation, people with ASD fail to imitate because they do not pay attention to demonstrated actions.
Thus, imitation difficulties in ASD reflect challenges gathering relevant information from the environment
through diminished or atypical visual attention to people and actions (Garfinkle & Schwartz, 2002).
Research suggests that the basic ability to follow and match the actions of others is challenging for
individuals with autism, especially when such actions are complex or unconventional (Smith & Bryson, 2007).
Compared with both typical peers and other disability groups, people with autism experience greater
differences with respect to imitation involving objects and body parts (e.g., gestures) (Dewey, Cantell, &
Crawford, 2007; Jansiewicz et al., 2006). People with autism may be able to imitate single actions (i.e., one-
step acts) but are less likely to imitate a variety of actions (i.e., multistep acts) compared with typical peers
(Gonsiorowski, Williamson, & Robins, 2016; Young et al., 2011).
Research has demonstrated that when individuals with autism are asked to imitate an unconventional
action with a common object (e.g., drinking from a teapot), they are more likely to make errors (Smith &
Bryson, 2007). Research has found that those with autism tend to use actions that are already part of their
repertoire. People with autism show variability in spontaneous imitation in natural contexts and the ability to
generalize and apply learned imitation skills to novel contexts (Ingersoll, 2008).
Another theory emphasizes that motor or sensorimotor (involving both sensory and motor) difficulties
might contribute to challenges in executing imitative actions. Gross motor, fine motor, and oral-motor
planning can be impaired or absent in people with autism (Bhat, Galloway, & Landa, 2012; Dziuk et al.,
2007; Green et al., 2002; Mari, Castiello, Marks, Marraffa, & Prior, 2003; Ming, Brimacombe, & Wagner,
2007). The ability to imitate and engage in gross motor movements, fine motor movements, and actions with
toys and objects can contribute to social learning (Lee, Lambert, Wittich, Kehavia, & Park, 2016). Research
on imitation skills in young children with autism has consistently shown challenges in both verbal and motor
imitation relative to cognitive tasks (Vanvuchelen et al., 2007; Williams et al., 2004).
Given the important role that imitation skills play in later development, current interventions should
emphasize teaching imitation skills. One approach to teaching imitation is behavioral, in which skills are
broken down into small steps and the child with autism follows the adult’s lead (McBride & Schwartz, 2003;
Smith, 2001). Another approach is a developmental approach, in which the adult shares the lead with the
child in a naturalistic setting (Ingersoll & Schreibman, 2006). When adults follow the child’s lead and imitate
his or her actions, an increase in social–communicative attentiveness and responsiveness occurs. Imitating
actions during activities provides a clear and predictable response and allows the child with autism to become
the initiator of the interaction. Shared imitative activity can provide a positive experience of shared nonverbal
communication for individuals with autism. Peer modeling, a strategy that applies imitation skills to natural

40
contexts, also appears to benefit some children with autism (Wolfberg & Schuler, 2006).
The following vignettes, which demonstrate imitation challenges in children with autism, suggest the
importance of the natural setting and the child’s motivation in learning to imitate others.

Isabelle was having no success imitating an adult in the context of an artificially structured activity. After months of
face-to-face contact with her teacher and practicing various fine motor movements, she was only passively cooperative.
Yet, in a different setting, she was following her peers’ play on the playground equipment, and she imitated the
children when they danced to music. Her ability to imitate seemed to be driven by motivation and meaning.

Jeb was unsuccessful in structured programs to build fine motor imitation. With toys and objects, however, he quickly
learned to imitate an adult’s simple play actions like other children.

SOCIAL SKILL DEVELOPMENT

Social development involves engaging in play and leisure activities, interacting socially with adults and peers,
and acquiring prosocial behaviors. Social skills encompass virtually every aspect of daily living, and social
competence is necessary for a child to function in all home, school, and community environments (Cacioppo,
2002). Social skills, along with social understanding, contribute to the development of social competence (see
Figure 2.2). Social competence or functioning is the ability to continually monitor and flexibly accommodate,
adapt, and adjust to ongoing social interactions. Unlike cognitive and language development, which are rule-
based, social development is dynamic and constantly changing. Social interactions demand moment-to-
moment interpretation and integration of multiple contextual factors, such as socioemotional understanding,
language, and prior experiences. The following sections contrast typical social skill development with
development of social skills in children with autism, with a particular focus on play and leisure activities, group
activities, and socioemotional relationships.

Figure 2.2. Social competence.

Play and Leisure Activities

Social skill development begins at birth, and early play and leisure experiences with self, objects, and others
contribute to our social understanding of the world (Beauchamp & Anderson, 2010). Play is defined as a
voluntary leisure activity engaged in for enjoyment. Play is the very fabric of childhood culture (Quill, 1995).
In fact, play is so important to optimal child development that it has been recognized by the Office of United
Nations High Commissioner for Human Rights (1990) as the right of every child and has become an integral
part of early childhood practices (National Association for the Education of Young Children, 2012). In this
discussion, the terms play and leisure activities are used interchangeably.
Engagement in play activities is a learning process, a social process, and an emotional process (Piaget,
1962; Vygotsky, 1964). In addition to allowing for object exploration, play provides an avenue for social and
self-discovery. Through play, young children explore their bodies, toys, and objects as well as learn socially
from adults and peers. As a child matures, interactions with peers increasingly become an avenue for social
learning, and there is a gradual decrease in the child’s reliance on adults for social and emotional support.
Research has demonstrated links among play and language, social, and sensorimotor development (Lifter,
Ellis, Cannon, & Anderson, 2005). Through engagement in play activities, children learn social skills such as
sharing, cooperation, and turn taking. Social language is learned and relationships are formed during
recreational activities with peers. Play and leisure activities encourage cognitive enrichment and emotional
growth and offer a means of exploring and practicing societal roles, rules, and problem solving. Imagination is
fostered through engaging in pleasurable, creative, and socially interactive activity (Lantz, 2001; Tsao, 2002).
Play—which can be a reenactment of previous experiences, a means to try newly acquired skills, or a novel
approach to both—is creative. Play is the full expression of all learning, relationships, and feelings (Ginsburg,
2007; Hurwitz, 2002).
Our discussion of early play and leisure is limited to two dimensions of play activities, which include

41
symbolic (exploratory, functional, and imaginative) and social (solitary and social). Children with autism
acquire skills within these play dimensions to varying degrees and experience a range of challenges and
difficulties in these areas.
Symbolic Dimension of Play and Leisure: Typical Development The symbolic dimension of play and leisure
is characterized by a child’s exploration of the world through the use of self, others, and objects. Symbolic play
is a critical social developmental milestone. As the child matures, play and leisure skills systematically progress
from simple or no engagement to increasingly varied, elaborate, and representational activities. In this text, we
use symbolic dimension of play as an umbrella term encompassing exploratory, functional, and imaginative play
(Stanley & Konstantareas, 2006). The following sections present the three stages of the symbolic dimension
of play (see Figure 2.3).

Figure 2.3. Symbolic dimensions of play and leisure.

Exploratory or Manipulative Children construct knowledge and learn about the world through the active
exploration of novel objects (Schulz & Bonawitz, 2007). Exploratory or sensorimotor play is characterized by
manipulating objects to obtain sensory input (Piaget, 1962). This type of play is evident in babies, who explore
the world through physical movement and sensorimotor experiences. Sensorimotor involvement with toys,
objects, and bodies helps individuals assimilate and explore the relationships among physical properties.
This early play with objects progresses from single, undifferentiated repetitive acts to sets of organized,
predictable actions to varied acts or combinations with an interest in cause-and-effect (Wolfberg, 2015).
Examples of exploratory play include simple movements such as mouthing, grasping, shaking, banging,
turning, and dropping objects. Simple movements then progress into action sequences such as lining up
objects or filling up and then pouring objects out of something. This play then progresses to performing
actions with objects, such as spinning a toy. This early object-directed play is important for the development
of meaningful perceptual representations and functional and symbolic play (Mastrangelo, 2009; van
Berckelaer-Onnes, 2003).
Functional Functional play refers to the ability to use familiar objects in conventional ways or how the
objects were intended for use (e.g., pushing a car, combing one’s hair) (Orr & Geva, 2015). Functional play
emerges by the end of the first year, typically between 8 and 11 months of age. With functional play, a child
engages in simple pretense and delayed imitation, mimicking familiar actions applied to objects, self, dolls, or
others. The child possesses a mental image of the function of the object that is tied to a physical action.
This type of play ranges from simple to more complex, elaborated forms, which can include conventional
association of two or more objects based on logically related properties (Williams, Reddy, & Costall, 2001).
Examples of simple functional play include constructive play activities such as stacking blocks or putting a toy
cup on a saucer. Using objects in this way can be learned through trial and error and not solely by observation
(Rogers, Cook, & Meryl, 2005). Examples of complex functional play include brushing a doll’s hair and
wrapping a doll in a blanket. Children then transition from the functional concrete to the symbolic pretend
use of objects.
Imaginative or Pretend When children are young, they may use make-believe to take on roles and create
imaginary situations (Walker, 2014). Through pretend play activities, children have opportunities to practice
and understand the social environment (Rogers et al., 2005). Imaginative or pretend play appears in many
different forms, with symbolism observed in the child’s ability to pretend that an object or situation is
something else. Different types of pretend play include 1) functional play with pretense (e.g., drinking tea
from an empty cup), 2) object substitution (e.g., using a block as a car), 3) imagining absent objects (e.g.,
talking on an invisible phone while holding hand near ear), and 4) assigning absent attributes (e.g., saying,
“the dog is hungry” when referring to a stuffed animal) (Barton & Pavilanis, 2012).

42
 This symbolic type of play emerges between 18 and 24 months of age. The first use of symbolism in play
is self-directed (e.g., feeding oneself with toy food props); then, there is a shift to other-directed (e.g., giving a
person a cup of pretend coffee) and finally doll or other object-directed (e.g., feeding a doll) play. The
transition to pretend play can be recognized when a young child begins to use sound effects or gestures that
are indicative of the referent behaviors (e.g., tilts head back when drinking from a cup that has nothing in it)
(Orr & Geva, 2015).
During imaginative play, children shift away from realistic props to other means of pretending, such as
object substitution. For example, an object might be substituted to represent another (e.g., pretending a banana
is a telephone, making a block a train) or attributed to having absent, false, or imaginative properties (e.g.,
pretending a toy stove is hot). During imaginative play, children may engage in role taking (e.g., talking for a
stuffed bear), and invent people and objects through language and gestures (e.g., waving to an invisible
friend).
As symbolic ability increases, children become more capable of combining several mental representations
into sequences (Orr & Geva, 2015). For example, children may organize play scripts that are related to
personal experiences (e.g., a mealtime routine). Pretend-play scripts might be initially organized around real-
life experiences with the use of realistic props (e.g., putting a baby in a bed to go to sleep) and later to roles
that move beyond real-life experiences (e.g., acting out roles from books and movies). Between 3 and 4 years
of age, children increasingly use fewer props and more language to narrate scripts, with sociodramatic play
(e.g., bride and groom getting married) common at this stage.
Symbolic Dimension of Play and Leisure: Autism Spectrum Disorder There are qualitative differences
observed in the symbolic dimension of play and leisure in autism (Kasari, Freeman, & Paparella, 2006).
Despite wide variability in the play and leisure behaviors in children with autism, certain differences appear
consistently compared to typical play development (Hobson, Hobson, Cheung, & Calo, 2015). A core
symptom observed frequently in autism is the atypical development of imaginative play (Hobson, Lee, &
Hobson, 2009). Previous versions of the diagnostic criteria for autism have included a lack of imaginative play
that is spontaneous, varied, and appropriate to developmental level (APA, 1994).
The natural flexibility and creativity of participating in play and leisure skills are generally not
demonstrated in children with autism (Thiermann-Bourque, Brady, & Fleming, 2012). Instead, ritualized and
perseverative play and leisure routines of various forms and content are commonly observed (Koegel, Koegel,
Frea, & Fredeen, 2001; Tanner, Hand, O’Toole, & Lane, 2015). Self-stimulatory body rituals and the
manipulation of one or more objects in a ritualistic fashion can be present as well (e.g., lining up toys by shape
or color or showing excessive attachment to specific items). Other object play ranges from simple, repetitive
play sequences to elaborate but exact play routines such as reenactments of book, television, or movie
segments. Although these resemble mature forms of pretend play, flexibility and imagination are missing.
During play and leisure situations, children with autism may engage in object exploration and functional
acts but minimal or no spontaneous imaginative or symbolic play (Loveland & Tunali-Kotoski, 2005). There
also can be differences in the number of functional and symbolic actions directed toward others when
compared with typical peers (Wetherby, Watt, Morgan, & Shumway, 2007). Children with autism may not
engage in age-appropriate play (National Research Council, 2001). For example, they might become intensely
preoccupied for long periods of time with the visual examination of just one object or an isolated part of an
object. When children with autism do engage in imaginative play, they tend to produce fewer novel play acts
and engage in less elaborate pretend play (Desha, Ziviani, & Rodgers, 2003). Children with autism show
reduced frequency, complexity, novelty, and spontaneity of pretend play compared with both typically
developing peers and children with other disabilities (Rutherford et al., 2007).
Object substitution, which can be performed using the perceptual qualities of the object and other
contextual cues, is observed in some children with autism. In contrast, forms of imaginative play or symbolism
that require the child with autism to generate pretend ideas with no external support are either absent or less
diverse, flexible, or varied, often appearing without direction or purpose (Wolfberg, McCracken, & Tuchel,
2008). There is some evidence that children with autism understand pretend play acts and can engage in
imaginative or symbolic play when given additional prompts and contextual support (Jarrold, 2003).
Nevertheless, they may be unable to generalize the skill to novel play contexts.
The play and leisure skills of children with autism are a window into what they may understand. The
repetitiveness of the play and the way they engage with leisure objects may reflect a more limited
understanding of how to use materials and objects in creative ways. This point was demonstrated by an
informal survey of the activity preferences of 100 young people with autism. Popular responses included the
following: playing physical games, using a computer, watching videos, looking at books, completing puzzles,
and playing video games (Quill, 1997). By nature, each of these activities is done in the same way again and

43
again, or, in the case of watching videos, information can be seen repeatedly in the exact same way. The
following vignettes illustrate symbolic play and leisure in children with autism.

John plays alone with toys for hours. Each time he plays with sand, he sifts it through his fingers. Each time he uses
blocks, he lines them up in a precise row. Each time he looks at a book, he counts the page numbers from cover to cover.
In every situation, his activity consists of one predictable behavior.

Eric enjoys playing with cars, but in a way that differs from peers his own age. His play can be described as “one toy,
one action.” He focuses on one aspect of cars and repeats the same action. Whereas typically developing peers are usually
interested in many things that cars can do (e.g., ride, go fast and slow), including in relation to other toys (e.g., carry
people, go to a garage), his play consists of spinning the wheels repeatedly.

Polly’s solitary leisure activity consists of elaborate reenactments of favorite books and videos. Line by line, she replays
the stories with objects as props. The reenactments are precisely the same each time. When someone tries to become part
of her reenactment or add a novel object, she moves away from the person.

Justin was learning to use playdough in a variety of ways. He initially preferred cutting little balls and lining them up
in a row. His teacher and peers showed him that other things could be built using animal- and letter-shaped cookie
cutters. The first day that his teacher was not directly involved in the activity, she watched Justin using the letter
cookie cutters. Within a few minutes he had spelled out Mighty Joe, the title of his favorite movie, in playdough.

Social Dimension of Play and Leisure: Typical Development The social dimension of play and leisure is
characterized by a child’s exploration of the world through solitary activity with self, social activity with peers,
and socioemotional relationships. Before engaging in social play, a child is considered to be unoccupied or an
onlooker observing others but not participating in activities (Fox, 2007). At each symbolic stage of play
(exploratory, functional, and imaginative), children tend to engage in solitary activity prior to social activity.
For example, during social play and leisure development, a child might first explore the environment and
watch others and then progress to associating and cooperating with peers.
Through social play and leisure activities, children share meaningful experiences and acquire critically
important social knowledge and skills. Although inherently pleasurable, play is a means to link the emotions
of self and others with various social roles and experiences. Play reflects an understanding of these social
experiences. The following sections present two social dimensions of play, which include solitary and social
play (see Figure 2.4).

Figure 2.4. Social dimensions of play and leisure.

Solitary Play and Leisure Solitary play is characterized as engaging alone in a leisure activity (Nelson,
Hart, & Evans, 2008). This type of play is marked by an absence of rules. Participation in solitary play and
leisure is intrinsically motivating and highly individualized and evolves differently depending on the age of the
individual. Infants study their body parts, toddlers run and jump, preschoolers dance and do somersaults, older
children engage in dreams and fantasies, and adults participate in varied solitary activities related to personal
interests. During solitary play, a person explores and examines how to use toys or materials.
Functional play schemes (e.g., cleaning a rug using a toy vacuum) develop during solitary play before
generalizing to social play, and imaginative-pretend play occurs alone before it occurs with others.
Imagination evolves through solitary play and leisure activities. Pretend play develops out of the ability to
assign novel meanings and actions to toys and objects. Children use toys and objects in creative ways, and they
embed imaginary people and objects into play. Young children may take on and reenact social roles from

44
personal experiences or take on roles from the world of make-believe while playing alone. They dramatize
various roles that derive from personal experiences or become characters from favorite books, television shows,
or movies. Children also assign roles to inanimate objects such as dolls or stuffed animals. Their dramatic play
themes become increasingly more organized and complex. Children initially show interest in peers by
watching other children while engaged in parallel (i.e., next to a peer) solitary play activities.
Social Play and Leisure Social play or leisure is complex and involves self-regulation and social
engagement with others. The ability to interact with peers is often considered the primary measure of social
competence (Lee, Odom, & Loftin, 2007). During social play, children explore materials (e.g., toys), watch
and imitate others, and progress to interacting nonverbally and verbally with peers. All of these components
occur simultaneously (e.g., do, watch, listen, say) and flexibly in typically developing individuals.
As children grow and develop, they move back and forth through different types of social play. Some
researchers have categorized these types of social play as 1) parallel, 2) associative, and 3) cooperative
(Papacek, Chai, & Green, 2016; Parten, 1932). At the beginning of social play, infants intermittently observe
and begin to imitate another’s play. Toddlers play parallel to peers and then engage in simple imitation games,
shared attention, and exchanges of positive and negative emotions. Interactions with peers then develop into
elaborate forms of associative (shared focus) and cooperative (shared goal) interactive play, with more
sophisticated language use within social activities (see Figure 2.5).

Figure 2.5. Types of social play.

These reciprocal peer interactions gradually expand in length, frequency, and complexity, with more
complex interactions involving more shared interests, social behaviors, communication skills, and pretend-play
skills. Social play requires self-regulation, social perspective taking, reciprocity, and creativity. Important
aspects of social play with peers include social interaction, reciprocal communications, and prosocial behaviors
(verbal or motor acts done to meet the needs of others):

Social Interaction: Social pretend play and leisure progresses from parallel activity (e.g., two children
pretending to drive their own school bus, two children playing at a sand table with their own buckets and
shovels) and evolves into associative (e.g., children playing together at sand table with each building own
castle but sharing shovels and buckets) and then cooperative play (e.g., one child is the driver while the
other children are the passengers on the same bus, children building a sand castle together). When children
first begin to interact directly with peers, they create joint or associative projects with objects but engage in
limited social exchanges. As cooperative play develops, children are able to interact and coordinate both
their activity and social behaviors with others (van der Aalsvoort & van der Leeden, 2009). Integrating
social imitation and imaginative play is essential for this level of peer interaction.
Reciprocal Communication: Communication with peers is naturally embedded into social interaction.
Children use nonverbal and verbal means to initiate and maintain interaction as well as to respond to
others. Getting a peer’s attention and peer entry strategies are primary communication skills that are key to
social success (Laugeson, Ellingsen, Sanderson, Tucci, & Bates, 2014). Toddlers initiate contact through
eye gaze, gestures, and physical proximity (Warren et al., 2006). Objects and toys are the focus of shared
attention. Preschoolers elicit peer attention by looking at peers, pointing to objects, and showing objects.
Although they use verbal means when interacting with adults, preschool children call their peers’ names or
use other verbal messages to initiate interactions less often. Thus, nonverbal communication is vital for
initiating and sustaining peer interaction among young children (Franco et al., 2003).
Prosocial Behavior: Prosocial behavior is another important element of peer interactions. Prosocial behaviors
are “acts of kindness” that characterize socioemotional development. Examples of prosocial behavior include
expressing positive attention, giving and sharing objects, providing assistance, giving affection, noting

45
 approval through words or emotion, and compromising (Svetlova, Nichols, & Brownell, 2010). In addition,
eye contact, emotional response through smiles and laughter, and physical proximity are key cooperative
acts that contribute to successful peer interactions. It is important to note that conversational abilities are
not considered a primary means to receive positive responses, nor are they necessary to engage in successful
social interactions. Table 2.3 summarizes important social developmental milestones for young children
related to play and prosocial behavior.

Table 2.3. Important social developmental milestones (12–60 months of age)

Age (months) Social skills
12+ Imitates simple adult actions
Shows interest in peer activities
Plays simple interactive games
Enjoys listening to simple stories
Enjoys rough-and-tumble play
Engages in parallel play
24+ Attempts to comfort others in distress
Begins symbolic toy use
Begins to share toys
Pretends adult roles in play
Imitates a task previously observed
Participates in supervised small-group games
36+ Shows preference for some peers over others
Labels feelings in self
Assumes different roles in play
Begins to take turns in play
Plays group games with supervision
48+ Has a preferred peer
Plays cooperatively with others
Develops a logical sequence of events in play
Follows rules in simple games
Recognizes another’s need for help and gives assistance
Shares and takes turns without reminders
60+ Responds positively to the good fortune of others
Has a peer group of friends
Follows community rules
Engages in complex adult role playing
Plays games requiring skill and decision making
Plays cooperative group games

Source: Centers for Disease Control and Prevention (n.d.).

The following vignettes demonstrate types of social play and leisure in typically developing children.

Parallel play: Jake and Billy are playing with blocks. If Jake wants a block that Billy is using, Jake takes it. If Billy
wants it back, Billy takes it. Each boy occasionally stops his own activity to watch what the other is doing. Their
interactions are limited to intermittent observation and brief nonverbal exchanges. They are both doing their own
thing!

Associative play: Greg, Doug, and Joey are playing with blocks. The boys proceed to build their own structures with
little to no conversing. One attempt to take a friend’s block is handled with a nudge. A second attempt to take someone
else’s block is handled by the boys nonverbally negotiating a trade. Greg makes sound effects that signal that his
building is a house on fire and he is a firefighter with a pretend hose. Doug narrates his own activity but does not seek
any acknowledgment from his friends. Joey builds his structure in silence and then follows Greg’s lead, also pretending
to be a firefighter. During the 10-minute activity, the boys say little to each other. Doug asks, “Hey, Greg, how’s this?”
and Greg says “Wow” several times. Joey calls his friends’ names a few times to indicate that he is happy to be a part of
the project. Their episode of play is dominated by imagination, joint focus on a project, and nonverbal interactions.

Cooperative play: Albert, Barry, and Qin are playing with blocks. The boys proceed to build some structures and are
talking to each other. Albert asks his friend for a block, and Qin hands it to him. Barry makes sound effects that signal
that his building is a house on fire. Albert says he is a firefighter with a pretend block hose and narrates that he needs
help to put out the fire. Qin follows Albert’s lead, also pretending to be a firefighter. During the 10-minute activity,
the boys are animated and talking to each other. Albert asks, “Hey, Barry, how’s this?” and Barry smiles and says “Fire
is almost out” several times. Their episode of play is dominated by imagination and joint focus on a project, with
nonverbal and verbal interactions.

Social Dimension of Play and Leisure: Autism Spectrum Disorder Engagement in play with peers serves an
important developmental role and influences social skills (Carter, Sisco, Chung, & Stanton-Chapman, 2010;
Gifford-Smith & Brownell, 2003; Rubin, Bukowski, & Laursen, 2009; Watkins et al., 2015). With regard to
the social dimension of play and leisure, children with autism may progress differently in the development of
social skills and prosocial behaviors necessary for play. Children with autism may lack nonverbal and
communication skills, interact primarily with adults and in solitary play, acquire skills in uneven sequences,
engage in restricted and repetitive routines, and lack cognitive flexibility, all of which can have an impact on
social engagement with peers.

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 Early social behaviors of joint attention, shared object manipulation, and imitation lay the foundation for
play, peer interactions, and social skill development (Adams, 2002; Clark, 2008). Atypical eye gaze, difficulty
shifting attention, and weak imitation skills are among the social qualities that characterize autism (APA,
2013). Some of these social behaviors, such as eye gaze within a social–communicative context, may not be
observed during development of an individual with autism at any age without intervention (Kasari et al., 2006;
Whalen et al., 2006). Without these skills, children with ASD miss out on numerous interactions, and the
most basic peer social interactions can be problematic (Krstovska-Guerrero & Jones, 2016).
The communication style and language competencies of children with autism, along with their ability to
understand emotional cues, can contribute to the number and quality of peer social interactions. For example,
some children with autism may not use verbal communication skills as a primary means to receive positive
peer responses or engage with peers, thereby missing out on a primary avenue of interaction. Peer
conversations offer a wide range of opportunities for mutual learning of social interaction as well as linguistic
skills (Blum-Kulka & Snow, 2004).
In children with autism, the quality and quantity of interactions with adults may differ significantly from
peer interactions. Children and adolescents with ASD may engage more frequently in social activities with
adults (e.g., parents) who are more predictable than peers (Orsmond & Kuo, 2011; Solish, Perry, & Minnes,
2010). The predictability of an adult’s interactions can increase the effectiveness of communication in children
with autism, whereas peers are less likely to adapt their communication style based on the needs of a child
with autism. Peers may misinterpret social–communicative efforts from a child with autism, and this difficulty
understanding their intent may result in poor responses (Wolfberg, 2015). Challenges with social and
communication understanding can thwart the attempts of a child with autism to coordinate activities with
peers. Because children with autism have unique behaviors, their social overtures may set them apart and make
them vulnerable to isolation, depriving them of opportunities to learn to socialize and play in conventional,
socially accepted ways (Wolfberg et al., 2008).
For children with autism, striking differences are noted in the quantity and quality of interactions with
peers as compared with typically developing children (Bauminger et al., 2008). Children with autism spend
less time participating in social interactions (McConnell, 2002), and initiate less social contact with peers
(Bauminger, Shulman, & Agam, 2003). Some children with autism may engage primarily in solitary play
activities (Anderson, Moore, Godfrey, & Fletcher-Flinn, 2004; Kamps et al., 2002). When children with
autism do engage with peers, their interactions appear to be less socially oriented (Bauminger-Zviely &
Agam-Ben-Artzi, 2014). Other key differences include challenges with playing in proximity to peers;
acknowledging the social initiations and responses of peers; demonstrating reciprocity and cooperation; and
maintaining social engagement in unstructured, naturalistic contexts (Bauminger et al., 2008; Koegel, Koegel,
Fredeen, & Gengoux, 2008; White, Keonig, & Scahill, 2007).
Children with autism may appear to prefer to play alone, but their aloofness may actually be the result of
skill deficits. There is evidence suggesting that children with autism have the same desire and capacity to play
with others as their peers (Bauminger & Kasari, 2000; Chamberlain, Kasari, & Rotheram-Fuller, 2007). A
challenge can be in the initiation of the social interaction, which is recognized as an area of challenge for
children with autism in several areas of functioning, including play with peers (Jahr, Eldevik, & Eikeseth,
2000). Some children with autism may be led passively into peer play but do not initiate peer interactions. Still
others initiate play interactions with peers, but their style appears awkward.
In autism, there can be uneven development within the social domain, which can impact play and peer
interaction. Children with autism appear to acquire some social skills out of sequence, whereas other social
skills are absent. For example, the ability to play simple interactive games is an early developmental skill that is
difficult for children with autism, yet playing games with rules, a developmentally more advanced form of
play, is an easier skill for some individuals with autism to acquire. This would be referred to as possessing
splinter skills—the child possesses an advanced skill but lacks some of the prerequisite background knowledge
in the skill area.
The unique play patterns of children with autism can be intensely ritualized and fall under restricted,
repetitive patterns of behavior, interests, or activities (APA, 2013). Children with autism may display
repetitive behavior during routinized play and a strong resistance to others who attempt to participate in or
disrupt their play rituals (Leon, Lazarchick, Rooker, & DeLeon, 2013; Rodriguez, Thompson,
Schlichenmeyer, & Stocco, 2012). Participation in leisure activities can be repetitive and idiosyncratic (i.e.,
peculiar or individualistic). Children with autism may demonstrate an inability to shift to new themes and
may fixate on a limited number of activities that are repeated and carried out alone for long periods of time
(Frith, 2008).
Children with autism may be less able to flexibly create novel play or leisure acts and often become “stuck”

47
in using contextually driven behaviors. Some children with autism are preoccupied with objects or narrowly
focused on unconventional interests instead of developmental and age-appropriate play or leisure activities
(Wolfberg et al., 2008). Leisure activities may include single-object rituals such as spinning objects. Other
play rituals may include lining up toys or obsessively and repeatedly watching one small segment of a video.
Some children engage in more elaborate play rituals, such as reenacting segments from a book or video
program from memory verbatim. Other individuals always want to win social games so that the game ends in
the same way. Some children also become intensely interested in a particular adult or peer and are vigilant in
their interactions with that person.
The developmental patterns of peer interaction can be related to the cognitive impairments that
characterize autism, with difficulty interacting with peers a characteristic regardless of cognitive skills (Hughes
et al., 2013; White, Keonig, & Scahill, 2007). Nowhere is the need to integrate and generate information
flexibly more at stake than during social activities. The rapid, transient nature of social interaction places
processing demands that pose great challenges for people with autism. Research suggests that structured
routines, activities, and environments, coupled with visual systems that communicate predictable expectations
and minimize competing distractions, promote active engagement through consistent, naturally reinforcing
consequences (Heflin & Alberto, 2001; McCormick, Loeb, & Schiefelbusch, 2003). For example, during peer
play, children with autism may be more socially responsive when they are able to predict the sequence of
events, and their social behavior may become disorganized when play is not predictable. The degree of
cognitive flexibility, as well as the presence or absence of core social–communication skills, determines the
degree of social flexibility observed in people with autism. Table 2.4 summarizes the characteristics of autism
in terms of social play.

Table 2.4. Social dimensions of play and leisure in autism

Social dimensions Tendency in autism Challenges
Solitary play and leisure Functional Imaginative
Perseverative Flexible
Contextually driven Spontaneous
Social play and leisure Passive or awkward Reciprocal communication
Parallel play Cooperative play

The following vignettes illustrate social play and social interactions in children with autism.

Frank watches his peers during structured activities and plays alone during unstructured activities. His ability to make
sense of his peers’ activities occurs only when they are all doing the same activity at the same time. When all of his peers
are doing something different, he chooses to play alone.

Tony struggles to understand how to interact with his peers. He wants to interact with others but does so by talking
about his favorite movie, The Sound of Music. Every day, he repeatedly asks peers questions about The Sound of
Music and becomes agitated when they do not know the answers to his questions or ignore him. He has difficulty
understanding that his interest is not shared by his peers. He has stated that the requirements of social interaction feel
overwhelming to him.

Kenny participates in many activities with peers. He and his peers swim, ice skate, ride bikes, and go skateboarding.
In addition, they go to the library, museums, bowling, and the movies. His mother finds that these activities allow her
son to share experiences with peers without any expectations to cooperate or converse. Any activity that requires
cooperation or conversation is frustrating for him.

Group Activities
Research suggests that children with ASD participate in group activities less frequently than typically
developing peers, and the range of group environments and activities they take part in is less varied (Hilton,
Crouch, & Israel, 2008; LeVesser & Berg, 2011; Little, Sideris, Ausderau, & Baranek, 2014). Specifically,
group participation appears to occur less frequently in unstructured and social activities (Hochhauser &
Engel-Yeger, 2010; Reynolds, Bendixen, Lawrence, & Lane, 2011). All group activities at home, in school,
and in the community pose the same challenges for children with autism as those found in play and leisure
activities.
Like play and leisure activities, groups vary in size and predictability. Group activities require a person to
demonstrate skills such as staying with the group, self-regulating, reading the social scene, staying on topic,
and adjusting according to perspectives. Group activities that are predictable—in which “everyone is doing the
same thing at the same time”—are easier for the person with autism to join and imitate. Parallel participation,
more predictable social interaction, and less social decision-making are required when a group activity occurs

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in unison (i.e., at the same time).
Group situations in which conversation is optional increase the likelihood that a child with autism will
fully participate. In addition, children and young people with autism often are more successful with group
activities that have a closed-ended, predictable sequence of events (e.g., activities and games with rules and a
clear beginning and end). In contrast, activities including random conversation and/or group activities that are
open-ended are the most challenging situations for them. The following vignettes demonstrate ways children
with autism might behave or respond during group activities.

Derek was preparing for a school holiday performance with his class. His teacher placed a blue piece of tape on the stage
floor to remind him where to stand. She knelt in front of him, touched his shoes, and said, “Toes stay on the blue.” The
teacher left the stage, and as the children began to sing, he stood on the blue tape, singing joyfully while leaning over
and touching his shoes. He was following his teacher’s gestural directions and did not notice that his behavior differed
from that of the other children in the group.

Sally’s ability to attend in her classroom varies according to activity. During reading time, she quietly focuses her
attention on the pages of the book because the group activity is organized, predictable, and sequential. When discussion
begins, she becomes distracted and disorganized and starts talking to herself. She is unable to follow the complexity and
random flow of group discussion.

Abby and her mother have made a list of all of the students in her class and decide daily who will be that day’s special
friend. This special friend is given a red ribbon to wear for the day. Any time she gets confused during group activities,
Abby can look for her special friend wearing the red ribbon to ask for assistance. This helps her participate in groups
more easily.

Community activities, which can be particularly complex, place some of the greatest demands on children
and young people with autism. Attendance at special event activities, such as family vacations and birthday
parties, have been reported as less frequent among preschool and school-age children with autism (Rodger &
Umaibalan, 2011). Similarly, adolescents with autism participate less frequently in recreational activities and
community activities (e.g., Scouts) than peers with and without disabilities (Lee, Harrington, Louie, &
Newschaffer, 2008; Orsmond, Krauss, & Seltzer, 2004; Solish et al., 2010).
Children with autism appear more successful in the community when efforts are made to preview
upcoming events ahead of time. This priming can help the individual be calm and organized in the setting and
increase skills (Genqoux, 2015). The following vignettes illustrate ways to help children with autism attend
community activities.

Pete was most relaxed during any rhythmic activity, such as listening to audio books or reciting the alphabet. He was
frightened of haircuts, so his teacher made a special storybook about getting a haircut and recorded an accompanying
song for him. He listened to the story and song and practiced getting pretend haircuts at school and the barbershop until
the actual haircut day arrived. He had mastered all the steps of getting a haircut except the actual snip. With all of the
supports and practice in place, Pete did fine when the barber made his first cut.

Kathleen went to church with her family. She sat quietly whenever the music was playing but looked for other things to
do when the priest was talking. She especially liked running up to people who wore hooded jackets so that she could
grab the string to twirl. Once a special church bag containing a favorite book along with a rosary (to twirl) was
provided, she was an “angel” at church.

Socioemotional Relationships
Relationships are built on mutually enjoyable, meaningful interactions. To experience friendships and ongoing
social connections, a person must have skills such as noticing that someone else has similar interests; accepting
differences; finding reinforcing ways to be together; and maintaining relationships over time, distance,
changing circumstances, and varying levels of intimacy (Frith, 2008). The cognitive and learning patterns
observed in people with autism profoundly influence their experience and understanding of social interactions
and can impact creation and maintenance of social relationships such as friendships. The number of social
relationships in people with autism can decrease with age, with adults having fewer friends than adolescents
(Orsmond et al., 2004) and adolescents having fewer friends than children of elementary school age (Locke,
Ishijima, Kasari, & London, 2010; Rotheram-Fuller, Kasari, Chamberlain, & Locke, 2010).
People with ASD may notice only extreme expressions of emotion and miss subtle socioemotional
messages, especially those related to complex emotions, and they may misinterpret the meaning of others’

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messages (Montgomery et al., 2016; Williams & Happé, 2010). People with autism may show greater
difficulties with cognitive empathy (i.e., correctly identifying other people’s feelings or beliefs and
understanding the reasons behind them) than with affective empathy (i.e., offer an appropriate emotional
response to another’s mental state) (Mazza et al., 2014; Montgomery et al., 2016). They may make concrete
and often incorrect associations between their perceptions and the meaning of social and emotional messages.
This can happen in direct interactions with others or, for example, in their interpretations of something they
viewed in a movie. Atypical or unexplained emotional responses can result from these misinterpretations.
The development of relationships is further complicated by the sensory sensitivities, anxiety, and
compulsive rituals present in some with autism. Sensitivity, hyperactivity, and distractibility may reduce
attention to social cues so that the person with autism is not aware of social opportunities or is unable to gauge
the appropriateness of social interactions. Or, the child with autism might play alone because he or she is
overwhelmed by the sensations encountered when engaging with others (Hilton, Graver, & LaVesser, 2007).
For example, sensitivity to sound or touch can affect a person’s level of comfort in being in close proximity to
other people. Sensory sensitivities might result in atypical ways of seeking comfort from others, and
attachments to significant people in the person’s life may be expressed unconventionally. Anxiety is also
shown to influence the quality of reciprocal interactions, as people who exhibit higher levels of autism
characteristics and high social anxiety report more loneliness than people lacking high levels of these traits
(Freeth, Bullock, & Milne, 2013; Reed, Giles, Gavin, Carter, & Osborne, 2016). Compulsive rituals also can
impede relationship building, because these sometimes highly stigmatizing behaviors can interfere with skill
acquisition and social interactions and set the child with autism apart from peers (Matson & Dempsey, 2008).
These factors all affect the development of meaningful, pleasurable relationships, which can be challenging
for children with autism and their families, teachers, and friends. The following vignettes show how some of
the characteristics of autism manifest within the context of relationships and include some examples of how
caregivers might mitigate attachment-related anxiety.

Justin is very attached to his mother, who has short blonde hair and wears glasses. At his new school, he finds comfort
by hugging a teacher who has short blonde hair and wears glasses. He cries with all other adults.

Joshua is very attached to his family. His separation anxiety started with him screaming each time someone in his
family left the house. Soon, just the sound of the garage door opening triggered an outburst. His teacher made a chart
called “Who’s at School; Who’s at Home” for the classroom. The students moved their photos to “school” upon arrival
and to “home” upon dismissal. This was successful in calming him at school, so his teacher decided to make a “Who’s at
Home; Who’s Outside” chart for his family. When his family left for work the next day, he began to scream. His mother
carried him to the chart and moved his father’s photo to “outside,” and he immediately calmed down. He pointed to
“Mom” on the chart for reassurance that she was “at home” and remained fine. The entire family continues to use the
chart because it helps him understand that they will eventually return any time they leave the house.

Leslie enjoys watching videos. When Leslie watches Disney movies with her family, her mother narrates the movie and
describes actions and feelings. After Leslie watched Bambi, which is a sad movie, the name “Bambi” soon became her
definition of “sad.” Thus, whenever she is sad, she says “Bambi.”

Tom’s mother died. He is nonverbal, and with his limited language understanding, his teaching team still felt it was
important to explain the loss of his mother to him. A book of photos of each family member was developed, with the
pictographic symbol for “sad” next to his mother’s picture and a symbol for “happy” next to photos of all other living
family members. He always carried the book in school and at home, and it was shared with him daily. A few weeks
later, his father commented that every night, his son went to bed with his photo album and opened it to the picture of
his mother. This ritual helped Tom get in touch with his feeling of being sad.

Ricky liked to complete puzzles with one particular girl in his class. His favorite puzzle was of a chicken. He became so
excited about playing with his friend that every day he asked her to play the chicken puzzle. Soon, he began to approach
her dozens of times a day, say “Chicken,” and laugh. He eventually became uncontrollably excited whenever he saw or
heard anything related to chickens. This was how he expressed the joy of his friendship.

COMMUNICATION SKILL DEVELOPMENT

The ease with which most children learn and use speech blinds us to the complexity of acquiring language and
communication. Communication is a social, reciprocal, and dynamic process. It is the instrumental force
propelling social knowledge, relationships, and a sense of self. Communication involves the transmission and

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reception of information. An effective communicator (sender/speaker) has an inherent need to interact
(motivation), a reason to communicate (purpose/intent), something to express (message), a means of
communication (system/medium), and someone with whom to communicate (receiver/listener).
With the emergence of language, children develop the ability to combine nonverbal and verbal means to
express a range of communicative functions and initiate, maintain, and terminate social interactions. Some
functions of communication (e.g., reasons to communicate) include to satisfy basic needs, exert control over
the environment, establish conversational exchanges, seek information, share experiences, express feelings, and
converse about past and future events. The complex dimensions of conversation—such as maintaining
appropriate topics, considering the listener’s perspective, and interpreting the nonverbal behaviors of others—
are learned and refined over the lifespan. Over time, children also acquire the ability to use nonverbal
conversational skills—such as appropriate physical proximity, voice quality, and eye contact—in flexible ways.
The ASHA web site provides, on average, the age by which most children accomplish speech and language
milestones. Important developmental milestones in the area of communication are summarized in Table 2.5.

Table 2.5. Important communication developmental milestones (12–60 months of age)

Age (months) Communication skills
12+ Produces intermittent verbal imitation
Combines gestures for basic functions
Plays simple interactive games
Combines gestures and words for basic functions
Indicates preference when given a choice
24+ Uses nonverbal means to initiate peer interaction
Comments on and describes ongoing events
Answers simple questions
Asks simple questions
Comforts others nonverbally
Maintains simple conversation exchanges with adults
36+ Retells a familiar story when looking at pictures
Relates a past experience when asked to do so
Labels feelings in self
Conducts intermittent conversational exchanges with peer
Engages in simple conversational exchanges on the telephone
Initiates peer interaction verbally
Uses body language and facial expression with messages
48+ Expands conversation skills with peers
Retells a popular story, television episode, or movie plot
Uses social phrases (e.g., “excuse me,” “sorry”)
Relates events in an organized, logical sequence
Recognizes how to respond to others’ feelings
Begins to interpret listener’s body language
60+ Communicates about a wide range of topics
Begins to take into account listener’s perspective
Adjusts conversation according to listener’s needs
Uses language to negotiate and compromise

Source: Centers for Disease Control and Prevention (n.d.).

Understanding Speech, Language, and Communication

Differentiating among speech, language, and communication is important for understanding the typical
development of communication and the challenges experienced by people with autism. A brief definition and
overview of each are provided in the following sections.
Speech Speech is the art of speaking. External speech is divided into spoken and written speech. Spoken
speech is the verbal means of communicating or the ability to use sounds, and it is an oral-motor skill that
follows a particular motor sequence (ASHA, n.d.). Speech sounds are the product of related processes that
include respiration (use of breath), phonation (muscle contraction that produces sound), resonation (throat
shapes the sound), and articulation (mouth movements form recognizable sounds). Most children learn to use
all speech sounds of their particular language by age 5 years.
Language Language is a formalized set of socially shared rules for using a conventional or structured set
of symbols (ASHA, n.d.). Language can take the form of 1) oral speech (e.g., by means of speaking or a
voice-output communication device), 2) sign language, or 3) written language.
Language consists of numerous rules that include phonology, morphology, syntax, semantics, and
pragmatics (see Table 2.6). Phonology, morphology, and syntax address the rules for the structure of language.
Semantics and pragmatics address the rules for language meaning and use in context.

Table 2.6. The rules of language

Terms Rules
Phonology Phonemes are smallest units of language (sounds)
Sequence sounds in a particular order
Morphology Morphemes are smallest units of language structure
Consists of sequenced phonemes
Word structure in a sentence (e.g., endings to mark plural [doll/dolls])
Syntax Grammar and the ordering of words in a sentence
Semantics Meaning created by words and word combinations in context
Pragmatics Language and nonverbal symbol use within social contexts

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 Words are symbols that represent concepts and reflect culture. Word meaning (semantics) is central to the
use of language. There is a vast difference between building vocabulary and using language with
communicative intent (pragmatics). Similarly, the ability to say words (phonology) or sentences (syntax) does
not guarantee the ability to use them for social communication (pragmatics). A person must apply and
understand pragmatic rules to effectively use and adjust verbal and nonverbal communication messages for a
variety of purposes, with an array of partners, and within diverse contexts.
The rules of language apply to both understanding (receptive language) and use (expressive language).
Receptive language is the ability to understand or comprehend the phonological, morphological, syntactic,
semantic, and pragmatic rules of language. It includes the ability to link word meaning to communication cues
and social content. In order to understand language meaning, the listener needs to consider the connection
between the speaker and the words within the social context. Elements to consider include 1) the
speaker/sender, 2) what the speaker says, 3) how the speaker conveys the message, 4) how the words relate to
what is happening, and 5) how the words relate to what the receiver/listener knows about the topic. For
example, if a speaker said a sentence with a frustrated tone of voice, the meaning of the words might change.
Expressive language is the ability to use the phonological, morphological, syntactic, semantic, and
pragmatic rules of language. These rules apply to using both oral and written language in conventional or
functional ways. Expressive language includes the ability to link language meaning to social content and
communicate using verbal and/or nonverbal messages. Expressive language develops as a result of
understanding and using elements that include 1) vocabulary (semantics), 2) sentence grammar (syntax), 3)
words and sentences related to context and what is happening (pragmatics), and 4) words and sentences that
will be understood by the receiver/listener. A speaker combines all of these language features in complex ways
to express wants, needs, feelings, and ideas. Cognitive, social, and emotional knowledge is interwoven with
the acquisition of language and meaningful language use.
Communication Unlike language, which is symbolic and rules based, communication is social and
constantly changing. Successful communication requires that an individual quickly attends to and understands
the meaning of rapidly changing multisensory, language, social, and affective information. Communicative
interactions require moment-to-moment integration of multiple contextual, language, social, and emotional
elements as well as an ability to make ongoing adjustments in response to the behaviors of others. Cognitive
capabilities, socioemotional understanding, language abilities, and prior experience all contribute to
communication competence.
Communication is more than being able to speak or being able to put words together in a proper order.
Communication is about knowing how to use words to relay intended meaning to a partner. It is about using
more than one sentence in a coherent manner to manage the flow of conversation. Just as every string of
words is not a meaningful sentence, not every sequence of messages is meaningful to the context or listener.
Communication involves engaging in discourse, either written or spoken. People communicate to let
someone else know that they want something, to tell someone about an event, to describe an action, and to
acknowledge another person’s presence. Communication is a verbal and nonverbal interactive exchange
between two or more people to express needs, feelings, and ideas, and it is a fundamental social skill.

Preverbal Communication: Typical Development

The development of communication begins in infancy with a simple smile. Typically developing young
children are communicators even before they say their first words, using multiple nonverbal means to express
wants, needs, feelings, and interests (Bates, 1976). Babies use and combine eye gaze, gestures, physical
proximity, facial expression (e.g., smiles), and vocalizations to purposefully interact with and provide clear
messages to others about what they want and do not want. The social conventions of communication are
learned and refined as the child grows. This section provides a developmental framework for the early phases
of language acquisition. The stages of early language acquisition are presented for approximate age ranges,
which overlap and are not definitive.
Generally between 6 and 12 months of age, typically developing children communicate using preverbal
communication that is reciprocal and intentional. Before the emergence of language, they initiate social
contact, observe others, and maintain reciprocal interaction through vocal babble, gestures (e.g., pointing,
giving, showing), and object play. This preverbal communication is used to call attention to themselves or
others and to direct another person’s behavior. Children of this age learn to initiate interaction and respond to
the overtures of others. The child engages in joint attention, imitation of simple actions or vocalizations, and
interactive turn taking with a back-and-forth style between the child and the communication partner. From
infancy, typically developing children exchange gazes and engage in vocal turn taking. Social activities such as
tickling, playing Peekaboo, and using toys to facilitate joint attention foster reciprocal interaction.

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 Adults play an important role in shaping early communicative interactions because they establish
predictable interactive routines. For example, studies have shown that when parents receive training in
interacting with the child with autism, progress is made in communication and language (Aldred, Green, &
Adams, 2004; Drew et al., 2002; Kashinath, Woods, & Goldstein, 2006; Ruble, McDuffie, King, & Lorenz,
2008; Siller & Sigman, 2002). Adults can facilitate communicative interactions through predictability,
simplicity, redundancy, exaggerated affect, and reference to objects and events in the child’s immediate
environment. The adult’s facilitative style of interaction can enhance reciprocal exchanges. For example, an
adult can shape his or her response contingent on the child’s behavior. Long pauses and nonverbal methods of
interaction provide children with frequent opportunities for communication (Potter & Whittaker, 2001).
When the child vocalizes, the adult responds to elicit more vocalizations. To maintain interaction, the adult
can adjust the amount of support provided to give the child a more active role in anticipating the adult’s
response, and the flow of social turn taking emerges. Soon, the child may initiate familiar turn-taking
sequences and learn to respond to the cues of the adult. This social reciprocity lays the foundation for
communicative competence.

Preverbal Communication: Autism Spectrum Disorder

The quality of social–communicative interactions can be remarkably different in autism, with the acquisition
of communication skills often following a unique developmental path. Differences are observed in the
functional use of language in the prelinguistic (before the development of language) stage in children with
autism. At the prelinguistic stage, nonverbal communication is limited to certain contexts. Eye gaze or gesture
is more likely to be used for the purpose of requesting rather than for sharing. A child with autism may use
pointing to request an object out of reach, but not to direct another person’s attention toward an object of
interest. Similarly, eye contact may be used to request but rarely to establish joint attention between another
individual and an object. Children with autism demonstrate greater success responding to communication
partners than initiating social interactions.
Limitations in preverbal communication have been attributed to a lack of joint attention skills (Adamson
et al., 2009). When a child with autism responds to a joint attention bid and looks at an object with another,
there is an opportunity to engage in meaningful communication. A child with deficits in joint attention,
however, may not respond to the bid for attention or coordinate attention toward an object, causing a
communication opportunity to be lost. Research has demonstrated that increases in joint attention skills result
in increases in social interactions, spontaneous speech, and expressive language (Whalen et al., 2006).
Researchers have shown that children learn object labels during joint attention interactions (Jones & Carr,
2004). As the child’s ability to respond to and initiate joint attention increases, so do the number and variety
of vocalizations (Jones et al., 2006).
In autism, communicative reciprocity may be present but may be less spontaneous and flexible and more
difficult for the child to maintain. To minimize change and maintain a limited (although somewhat
successful) style of interaction, a child with autism often insists on specific, routinized interaction patterns.
These communication patterns occur because the child may have a limited ability to analyze and integrate
social information in a cohesive, fluid manner. Thus, the child often is left with a series of fragmented
experiences that lead to ritualized, context-specific communicative behaviors (i.e., the child often associates a
particular context with a specific communicative behavior, appears less able to see the similarities of related
social situations, and struggles to respond flexibly). This creates difficulty generalizing communication skills
across related contexts and responding to the dynamic and unpredictable style of typical social–communicative
interaction.
The communication style and role assumed by the communication partner account, in part, for how
successful people with autism are in social interactions. Individuals with autism struggle more when there is a
discrepancy between their communication style and the demands of the social situation and partners. In
communicative exchanges, the child must know and understand both the role of initiating communication
and the role of responding to information. Yet, adults often anticipate and respond too quickly to the needs of
children with autism, without expecting the child to initiate interactions. Many children with autism are
placed in the role of responding to requests or commands. For example, a child with autism might be asked,
“What do you want?” before he or she has an opportunity to initiate a request. Questions often can limit the
flow of interaction. Strategies that promote communicative initiations and reciprocal interactions are a key
ingredient of successful intervention for children with autism.

Verbal Communication: Typical Development

Verbal communication is predominantly interactive (i.e., used with social intent) but can also be

53
noninteractive (i.e., used as a means of self-regulation). The social functions of communication include
responding to others, initiating various requests, and sharing ideas and feelings. Noninteractive use of
language (i.e., talking to oneself) is a means of regulating thought or behavior. With the emergence of
language, children develop a variety of verbal along with nonverbal means to express the full range of social–
communicative functions. Children satisfy basic needs, exert control over the environment, establish social
relationships, ask for information, share experiences, and express ideas and feelings through language. Studies
have found that typically developing children use the full range of communicative functions across structured
and unstructured contexts from the prelinguistic to multiword stages of language development. In typically
developing children, language develops from single words to word combinations to sentences to complex
language.
First Words Generally between 12 and 18 months of age, typically developing children use spontaneous
(not imitated) single words referentially and symbolically to communicate intelligibly about objects and events,
including those outside the immediate context (Luyster, Lopez, & Lord, 2007). As they mature, they use
increasingly more words with a variety of individuals in different settings, and their words serve most social
functions, including labeling, requesting, and commenting. By age 2, children understand what others say by
relying on contextual cues to figure out the meaning of words. Between 21 and 24 months of age, children
refer to self by name and use early pronouns (e.g., me, my, mine). Children commonly stake claims to their
objects by saying “mine” and can recognize their image in the mirror as “me.”
Word Combinations Generally between 18 and 30 months of age, the vocabulary of typically developing
children rapidly increases in size and parts of speech (e.g., nouns, verbs, descriptors) (Oller, Oller, & Badon,
2012). With the emergence of word combinations, a child’s repertoire of communication skills becomes more
complex. Children combine words creatively to refer to objects and events and use two- and three-word
combinations for a wide range of communicative functions. Through language, children develop the ability to
combine nonverbal and verbal means of communication to initiate, maintain, and repair reciprocal social
interactions. Children at this phase can maintain interactions through speech, eye contact, and nonverbal
means of communication and can use words and facial expressions to ask for clarification. Through language,
they can communicate their needs, express their ideas, seek information, share experiences, and express
feelings.
Sentences Generally between 24 and 48 months of age, typically developing children combine words into
structures, or sentences, and begin to use some plurals, prepositions, and verb endings (morphology).
Typically developing children rapidly acquire an understanding of vocabulary (semantics) and language
grammar structures (syntax) and use them proficiently by the time they reach preschool age. Children
communicate a wide range of functions in different settings with both familiar and unfamiliar people. With
more language, children can engage socially in richer back-and-forth conversations.
It is important to understand that language is a formal symbol system that has structural qualities (e.g.,
semantics, syntax) and includes speech, sign language, written language, and other graphic symbols.
Intervention to build language is primarily aimed at expanding vocabulary and grammatical complexity. In
contrast, communication is a social exchange. Language is one vehicle used to communicate. Nonverbal
messages such as eye gaze, gestures, facial expressions, and other expressions of affect are equally important
vehicles of communication. Effective communication can exist in the absence of language, as shown by the
communicative behaviors of infants. Furthermore, language can exist in the absence of communication, as is
often observed in individuals with autism. The components of communication are pictured in Figure 2.6.

Figure 2.6. Components of communication.

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Verbal Communication: Autism Spectrum Disorder
In addition to the core social–communication deficits (i.e., joint attention, imitation, use of multiple
nonverbal behaviors), vocalization differences are observed between children with and without autism
(Sheinkopf, Muncy, Oller, & Steffens, 2000; Werner & Dawson, 2005). A growing body of research provides
evidence of a relationship between early vocalizations and later expressive language (Watt et al., 2006).
Delayed onset of speech and lack of language or loss of words are some of the most common early symptoms
in children with ASD (Johnson & Myers, 2007). However, it is important to note that people on the autism
spectrum range from those who are nonverbal to those who remain minimally verbal to those with a high
language proficiency (Boucher, 2012; Weismer & Kover, 2015). In the DSM-5 (APA, 2013), delayed or
impaired language is no longer a core symptom of autism, although comorbid language disorders are to be
noted (Tager-Flusberg, 2016).
At both the prelinguistic and verbal stages, most communication efforts of children with autism serve the
functions of requesting or rejecting, not the purposes of sharing information and feelings. Children with
autism may request objects, food, or assistance, but they rarely spontaneously comment on something of
interest, express feelings, or use other prosocial statements (e.g., “thank you,” “goodbye”). They understand
and use communication that has a clear and immediate effect on the environment, but the social means to
draw attention to oneself and engage others may elude them. Requests (e.g., “I want juice”) or rejections (e.g.,
“No, I don’t want that”) are linked to tangible contextual cues (the desired or rejected item) and consequences
(providing or removing item). The following vignettes illustrate characteristics of verbal communication in
children with autism:

Lance arrives at school every day with a smile. He stops at the doorway and his teacher says, “Good morning, Lance,”
to which he replies, “Good morning, Ms. Anne.” His teacher then directs him to put his things away. This exchange is a
daily routine. One morning, Anne was out of the classroom when Lance arrived. He stood at the doorway and waited.
Becoming increasingly agitated, he stated, “Good morning, Lance; good morning, Lance. Say ‘Good morning,’ Ms.
Anne. Good morning, Lance.” He stood and rocked at the door, repeating the words that, in his mind, initiated the
arrival routine.

Bruce used speech to request food and objects but never commented about his activities. Yet, Bruce was interested in a
peer’s augmentative and alternative communication (AAC) system. One day during snack time, Bruce sat next to his
friend and used the voice output system to comment about his snack. “This is good,” he said. Bruce also used it to
comment on another child’s behavior by saying, “Mad, loud.” The symbols on the AAC device served as a concrete
reminder to Bruce of things he could say.

Nina screamed when people were too close to her. Her educational team implemented many intervention plans to get
Nina to replace screams with the phrase “Move away, please.” She was so anxious during the actual situations that she
was unable to organize herself to use these words. Because Nina was so motivated by videos, her teachers decided to
create video examples of family members and school friends saying “Move away, please” when others were too close.
There were 10 different episodes on the final video. Nina was interested in the video, and soon after she viewed it, she
began using the words “Move away, please” with prompting.

It appears that for people with autism, their style of communication stems not from an unwillingness to
share information spontaneously but from a difficulty generating novel information without contextual cues.
Because verbal and nonverbal patterns of communication are contextually driven for children with autism,
clear contextual cues can guide the communicative behaviors of these children, as illustrated in the vignettes.
The DSM-IV (APA, 1994) previous diagnostic criteria for autism included using language that can be
stereotyped, repetitive, or idiosyncratic. Echolalia—the repetition of others’ speech either immediately or at a
later time—is a common type of stereotyped language in many verbal children with autism, which is used for a
variety of interactive and noninteractive functions. In the process of acquiring language, typically developing
children may use imitation and the repetition of spoken language for functional communication, especially
when they are young. During the early stages of language acquisition, it may be difficult to discriminate
typical from atypical verbal repetition in young children; therefore, echolalia and imitative language are not
used to classify a child with autism (Tager-Flusberg et al., 2009b).
Stereotyped language such as echolalia consists of scripts heard in previous contexts repeated in
noncommunicative ways and represents atypical imitation behaviors (Volkmar, Paul, Klin, & Cohen, 2005).
Echolalia typically reflects context-specific learning of whole messages. Generating novel ideas and messages
is more difficult for people with autism because it is an analytical process that requires flexibility in thinking

55
and planning. People with autism use echolalia for a variety of reasons. Echolalia may be directed toward a
social partner to request or reciprocate. It can be used to initiate communicative acts (e.g., requests, calling,
protesting) or maintain communicative exchanges (e.g., turn taking, providing information). Other forms of
echolalia are used by the individual as a noninteractive means of self-regulation. Some forms of echolalia may
be highly automatic and nonfunctional, without any reference to people or objects in the present context.
Echolalia can be manifested in various ways:
• Immediate echolalia, the partial or exact repetition of a message immediately after it is heard, is common. It
is the imitation of what has been heard, directly after it is spoken. Unfortunately, many children with
autism often learn to repeat what is said without understanding the meaning of the message.
• Delayed echolalia, the partial or exact repetition of a message at a significantly later time than when
originally heard, also is common in autism. It is linked to a specific person or setting and reflects the
individual’s struggle to effectively connect language meaning with events.
• Mitigated echolalia is a repetition in which the original stimulus is somewhat altered.
The following vignettes illustrate various forms of echolalia in children with autism.

Danny enjoys listening to books that have audio available. He quickly memorizes a book and then repeats the entire
book, including the sound effects that indicate that it is time to turn the page.

Bobby has been taught to imitate language out of context. A typical exchange between his teacher and Bobby follows:
Teacher: Bobby, what is it?
Bobby: What is it?
Teacher: Say, “It’s blue.”
Bobby: It’s blue.
Teacher: Good job.
Bobby: Good job.
Teacher: (presents next item).
Bobby: What is it?
Teacher: Yes, what is it?
Bobby: What is it?
Teacher: Bobby, look; say, “green.”
Bobby: Say green.

Bobby obviously understands that communication is an exchange; however, he does not understand the
meaning of the messages shared.

Although she spoke in full sentences, Kim’s communicative intent often was difficult to determine. Kim’s favorite
activity was watching videos, so she made associations, based on some concrete similarity, between people she met and
characters from a video. The first time she met her teacher, Kim said, “There’s no place like home; there’s no place like
home.” Her teacher was wearing a pair of red shoes and this reminded Kim of Dorothy’s ruby slippers and famous
words in The Wizard of Oz. During the entire school year, Kim would say, “Good morning, Ms. Sandy; there’s no
place like home” each time her teacher wore those shoes to work.

An additional characteristic associated with echolalia is difficulty with pronoun use. Pronouns come with
rules, so even typically developing toddlers get them confused during their acquisition period. Through
exposure to language, most children learn pronoun information incidentally as they mature. Pronoun reversal
is associated with echolalia and common in individuals with autism, with reference to themselves as he, she, or
you or by their own names (Volkmar et al., 2005). Children with autism may refer to themselves as they have
heard others speak of them and misapply pronouns. The following vignette provides an example of this
characteristic.

Jared’s father travels frequently for business. When he arrives home, he will ask Jared, “Did you miss me?” (question).
Jared’s response is “I missed me.” (response).

Complex Language and Conversational Discourse: Typical Development

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Language appears to develop effortlessly for the typical child, who is neurologically ready to master the
language of any culture from birth. During the preschool years, typically developing children rapidly acquire
vocabulary and go through the process of using the language structures they hear (e.g., English, Spanish). A
key indicator of children learning language is seen in errors, such as using words like “goes” for went or “foots”
for feet. By the end of preschool, typically developing children are using their expanding vocabularies to
communicate and are using complex grammatical constructions (e.g., anaphora) in various discourse contexts
(e.g., conversation, narrative). Conversational discourse sounds different depending on the communication
partner. For example, children converse differently when they speak to a peer versus an adult or a friend versus
a stranger.
Adult–child conversations contrast sharply with peer–peer conversations. For young children, there is a
significant difference in the quantity and quality of verbal interactions with adults as compared to interactions
with peers. When the play of 2-year-old, 4-year-old, and 6-year-old boys was recorded on video for analysis,
peer interactions were dominated by nonverbal social behaviors and expressions of emotion (Quill & Bracken,
1998). There was more communication among the 4- and 6-year-old boys, even though it typically was either
single exchanges (e.g., question and answer, comment or verbal acknowledgment) or parallel talk (e.g., talking
about one’s ideas and feelings with nonverbal acknowledgment). Overall, however, there was a striking paucity
of conversation among peers. The same play contexts with adults revealed more elaborate conversational
exchanges. The following vignette provides an example of this characteristic.

Christopher, while playing with his mother, said, “Look at the dump truck,” “No, I don’t want to give him a ride,” and
“I need some dirt.” When Christopher later engaged in the same activity with a peer, his language was typically single
words, such as “no” and “mine.”

Typically developing children quickly gain conversational proficiency with their peers. For example,
toddlers engage in intermittent social exchanges with their peers. Preschool children adjust their verbal and
nonverbal behavior according to peer feedback. They adapt their language complexity and nonverbal
conversational style according to the age, language level, and social level of the listener. They persist in their
communicative efforts in order to be understood and learn the skills of clarification. By the time children enter
elementary school, conversation becomes the focus of social activities with peers, and they continue to refine
verbal and nonverbal communication skills. They become skilled at reading facial expression, tone of voice,
and body language and adapt their verbal information to the needs of their communication partner. Successful
social conversation parallels other important aspects of social play: reciprocity, turn taking, and responsiveness
to others.
Through the school years, the vocabulary of typically developing children continues to grow along with the
use of more complex sentence types and increased language competence. Language competence is linked to
the ability to integrate personal experiences, social experiences, and knowledge in flexible ways. Over the
course of their education, typically developing children acquire literacy skills (reading and writing abilities)
and master knowledge of spoken and written language needed for academic and social success.
Refinement of conversational skills across different social contexts and communication partners is a
lifelong developmental process that continues into young adulthood. Throughout childhood, children
continue to develop more complex conversational skills such as maintaining appropriate topics, considering
another’s perspective, and interpreting the nonverbal communicative behaviors of others. The child also gains
awareness of social roles—for instance, learning that he or she would speak differently to a friend versus an
authority figure. During a conversation, individuals are expected to engage in social actions that are consistent
with the expectations of one’s culture, such as assisting someone who needs help, patiently waiting for a turn
in a game, or not making unkind remarks even if truthful.
Society also requires that one knows how to use a polite manner of discourse. At the same time that they
choose words and sentences, children must select nonverbal features (e.g., vocal quality, eye gaze, physical
proximity) that are appropriate to the circumstances. Children acquire the ability to flexibly use nonverbal
conversational skills, such as voice quality and eye contact, across different social contexts and with different
communication partners (Vicker, 2009). Quantity also is important in conversation; the speaker needs to
provide enough information so that a communication partner understands but not so much as to assume he or
she knows nothing or needs to know everything about a topic. Children also learn conversational repair,
which involves recognizing that there is a breakdown in communication and subsequently repeating,
rephrasing, or adding information strategies to aid comprehension. Box 2.1 titled “Basic Requirements for
Successful Conversation” captures conversation in all its complexity:

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 Box 2.1. Basic requirements for successful conversation
• Paying attention to multiple aspects of the speaker’s message
• Processing multiple aspects of the speaker’s message
• Interpreting the intent and meaning of the speaker’s verbal, nonverbal, and affective behaviors
• Processing the speaker’s message in relation to the social context
• Understanding the partner’s mental state—what the partner knows, understands, and feels—in order
to monitor the conversation’s relevance for the other person
• Organizing ideas related to the topic of conversation and the partner’s needs
• Retrieving information relevant to the topic, partner, and context
• Conveying intent and message with verbal, nonverbal, and affective behaviors
• Conveying message relevant to the topic, partner, and context
• Taking turns
• Adapting to the ongoing, changing social dynamic
And doing all of these pieces simultaneously!

Conversation skills interface all of the core, social play and leisure, and communication dimensions
discussed thus far in this text. Three particularly important elements of conversation include turn taking, topic
maintenance, and perspective taking. There also are multiple features of nonverbal communication in
discourse that contribute to meaningful and successful conversation. These include proximity, body language,
and affect. The key verbal and nonverbal elements of effective conversation will be discussed in the following
sections.
Turn Taking The first main element of conversation, turn taking, requires an ongoing adjustment to the
context, partner, and topic (Vicker, 2009). It includes the ability to recognize opportunities to initiate,
interrupt, and maintain the flow of conversation. The communicator can take the role of initiator (at onset of
a conversation or to maintain the conversation) or responder (by responding to initiations of others and
maintaining the conversation). Turn taking involves taking a turn in conversation at the appropriate time,
recognizing the signal that a turn has ended, and limiting talking to one’s own turn.
Topic Maintenance Topic maintenance involves identifying topics that are appropriate to the context and
using a variety of topics in conversation. Topic maintenance also involves staying on the topic unless there is a
signal by the communication partner that a change is happening and knowing how to smoothly introduce a
topic shift (Vicker, 2009). Information added during a conversation should be relevant to the topic at hand.
Perspective Taking The third and most essential aspect of successful conversation is taking into account
the perspective of the communication partner. Perspective taking is the ability to continually monitor and
adapt content and communicative style to suit the needs of the listener. It also requires the skills of being able
to seek clarification and accommodate listener needs. Over time, children develop the ability to understand
that others have thoughts, ideas, experiences, and feelings that differ from their own (i.e., ToM; see Chapter
1). The ability to understand the perspective of others plays a significant role in communicative interactions.
For instance, in conversation, it is important to continually monitor what the communication partner knows
and expects in order to make information relevant. Only with this social perspective can a person interpret the
meaning and intent of what others are saying. Social perspective taking also allows individuals to continually
adjust their own language and communication with others. With all of these essential skills, they can have a
conversation about present, past, and future events.
Proximity Proximity is the ability to maintain appropriate distance and orient to a communication
partner. It is the use of one’s body in space and can carry meaning all by itself or be combined with other
paralinguistic (i.e., social meaning, not language based) features. Standing too far away from a communication
partner may be perceived as disinterest, whereas standing too close may make a person feel uncomfortable
(Gessaroli, Santelli, di Pellegrino, & Frassinetti, 2013; Kennedy & Adolphs, 2014).
Body Language Body language either supports or detracts from the communicative message and is
considered an integral part of conversational competence. Body language and gestures can profoundly
influence the meaning of the spoken message. Conventional gestures are those that have a meaning in a
specific culture. Examples of gestures include a thumbs up, a high five, a handshake, a pat on the back, and a
social kiss.

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 Affect Affective cues also influence the communicative message and are considered an integral part of
conversational competence. The use of eye gaze, facial expressions, and gestures is an important means to
convey affect. Eye gaze during a conversation can suggest meaning such as interest in the interaction, shared
attention, truthfulness, and other messages. Eye gaze also is used to monitor the nonverbal communication of
the partner. Facial expressions can carry meanings in a spoken message; for example, they can contradict or
amplify a spoken message (Vicker, 2009). The emotional message conveyed through facial expressions can be
enhanced by the prosody features of one’s voice. Prosody involves the meaning conveyed by the use of one’s
voice or intonation to emphasize emotional state. Intonation can profoundly influence the meaning of the
spoken message.

Complex Language and Conversational Discourse: Autism Spectrum Disorder

The complex, ongoing adjustments and modifications inherent in conversation can challenge even the most
capable person with autism. A stereotypic, routinized style of interaction can dominate discourse skills (i.e.,
use of words to exchange thoughts and ideas) in autism. Situation-specific language, repetitive or perseverative
questions, preoccupation with a narrow range of topics, and routine scripts can typify conversation (de Villiers,
Fine, Ginsberg, Vaccarella, & Szatmari, 2007; Paul, Orlovski, Marcinko, & Volkmar, 2009). Conversation
requires the ability to shift attention rapidly across a number of social and language elements, to hold in mind
one’s own thoughts and simultaneously process the communication partner’s message, and to recall
information relevant to the topic.
Impaired attention, processing, and social cognition can all contribute to the discourse difficulties observed
in autism (Beauchamp & Anderson, 2010). The inability to initiate novel messages can result in individuals
with autism remaining fixed in repetitive discourse patterns. Because of a constrained ability to consider the
perspective of others (Baron-Cohen et al., 2000) during conversation, people with autism may show a limited
awareness of speaker/listener roles and have difficulty maintaining topics and repairing conversational
breakdowns. This is coupled with a poor understanding of the meaning conveyed by nonverbal cues such as
facial expression, body posture, and paralinguistic (e.g., pitch, loudness, rate, fluency) features.
The development of conversational ability in children with autism is different from that of typically
developing peers. In typical development, as language increases, there is a parallel increase in conversation
skills, with children able to add novel information, introduce new and related topics, and use effective
nonverbal strategies. In comparison, as language ability increases in children with autism, associated increases
in conversation skills are not observed (Tager-Flusberg et al., 2009a). Researchers have found that individuals
with autism who correctly complete ToM tasks show better conversational skills and social insights than those
who cannot perform the same tasks (Frith, 2001; Tager-Flusberg & Joseph, 2005b).
As expected, verbal individuals with autism constitute a diverse group. Some appear only to understand
the turn-taking quality of conversation and engage in repetitive questions or statements to maintain a
predictable interaction and response from a partner. In others, a propensity for detail results in literal
interpretations and responses during conversation. Many people with autism use pedantic (i.e., formal and
literal) speech and can perseverate on a topic of interest to them with no apparent recognition of cues from the
listener. Others use metaphoric (i.e., comparison of one thing to another without the use of like or as)
language, so the intent and the meaning of the message are unclear to the listener. People with autism may
make idiosyncratic (i.e., peculiar or individualistic) associations between things that are unrelated, resulting in
messages that appear out of context. For example, a child with autism sees a friend after many months and
opens the conversation by asking, “Was your hair long or short?” The adult who knows the child’s intent
understands that the question means “When did I last meet with you?”
Furthermore, studies have demonstrated that people with autism have difficulty recognizing and
interpreting affect and facial expression in natural social situations (Eack, Mazefsky, & Minshew, 2015;
Harms, Martin, & Wallace, 2010). Although able to identify individual elements of affect in isolation (e.g.,
emotion, facial expression, gestural meaning, tone of voice), children with autism appear unable to integrate
and act on these multiple nonverbal features of conversation that occur simultaneously in natural contexts.
Children with autism do their best to interact with others, applying their own understanding of the situation.
The following vignettes display the conversational efforts of two children with autism.

The process of teaching conversation exchanges to James was an education for his teacher. Just when she thought that
James had learned to generalize a particular message, he would remind her of his stereotypic, routinized style of
interaction. For example, James had been practicing asking the question “Where is ______?” through many games and
activities. One game entailed his posing the question “Where is ______?” Then, they would go on a treasure hunt, find
the item, and James would say, “I found it.” One day, he was looking for a program on his computer. His teacher asked,

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“Do you want the computer program? Where is it?” After looking among the programs on the computer for a few
minutes, James announced, “I found it.” His teacher said, “Where is it? You found it?” James replied, “Where is it?” and
the circular conversation continued. James comprehended many pieces of the “say-search-find” activity, but the exact
meanings of the words continued to elude him, particularly when they were used in a new context outside of the typical
conversational routine with his teacher.

Shana is striving to understand other people’s feelings. Her struggle to comprehend the sentiments of others is
demonstrated by the following conversation between Shana and a visitor to her classroom:
Shana: Were you here before?
Visitor: Yes, I visited your school in October.
Shana: Was your hair long or short?
Visitor: My hair looked almost the same.
Shana: I remember it longer. I don’t like it now.
Visitor: Oh, I like it.
Shana: What I said, how do you feel?
Visitor: A little uncomfortable.
Shana: What I said, and now you’re sad?
Visitor: Yes, I’m a little sad. I like compliments. Do you remember learning about giving compliments?
Shana: Yes. Next time I will say, “I like your hair,” and you will be happy.

Communicative flexibility poses a challenge for people with autism. Routinized communication patterns
appear to be the means for some individuals with autism to create meaningful interactions amid perceived
social chaos. Even though people with autism experience varying degrees of challenge with communication
skills, in all cases, teaching those with autism to become attuned to the multiple dimensions of social–
communicative interaction is a formidable task.

RESTRICTED, REPETITIVE BEHAVIOR IN AUTISM

In addition to challenges with social and communication skills, the other primary characteristic of autism is
engagement in restricted, repetitive patterns of behavior, interests, or activities. The presence of repetitive
behavior patterns is what separates autism from other social and communication disorders. Although autism is
identified by these ritualistic and idiosyncratic patterns of behavior, it continues to be the least understood
symptom. Increased research is needed to understand the source of ritualistic behavior in autism, as well as the
relationship between ritualistic behavior and related anxiety disorders, obsessive-compulsive disorders, and
other neurological disorders (Gabriels, Cuccaro, Hill, Ivers, & Goldson, 2005).
The presence of restricted, repetitive patterns in autism is determined when some of the following features
are observed: stereotyped and repetitive gestures or movements; restricted or intensely focused interests; rigid
desire for sameness; insistence on routines and rituals; inflexible adherence to specific, nonfunctional rituals;
and/or atypical responses to sensory environmental input (APA, 2013). Engagement in restricted, repetitive
behaviors can shift attention away from the environment and make the child unavailable to meaningful input
that promotes social and communication development (Bishop, Richler, & Lord, 2006; Bodfish, Symons,
Parker, & Lewis, 2000). This lack of attentiveness to the environment can lead to delays in the development
of skills (Lewis, 2004; Richler, Heurta, Bishop, & Lord, 2010).
Ritualistic behaviors also can have an impact on autism severity, which is determined by the degree to
which behaviors interfere with functioning in a variety of contexts and cause distress to the individual.
Research has demonstrated that more intense preoccupations, focused interests, sensory sensitivities, and
stereotyped motor movements predict less developed cognitive and adaptive skills and greater autism symptom
severity (Troyb et al., 2016). See Table 2.7 for an overview of restricted, repetitive patterns of behavior as
described in DSM-5 and examples of how these patterns of behavior manifest as social and communicative
rituals.

Table 2.7. Social and communication ritual examples

Description Social rituals Communication rituals
Repetitive motions, object use, or ways of speaking Flap arms, rock, or other stereotyped motions Echolalia
Repeatedly spin, flip, or line up toys Unusual sounds or nonsense words
Desire for sameness and routines; inflexibility and resistance Must eat same food, wear same clothing, or watch same show every day Ritualized conversations with others (e.g., specific way to
to change; ritualized behaviors Inability to tolerate any change in daily routine greet or say goodbye; ask same questions and expect same
Struggle to transition between activities answers each time)

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Narrow, intense interests Collect one particular toy or type of object obsessively Perseverate on one topic when talking with others
Reenact or repeat lines from movies or books
Unusual sensory responses (hyper- or hyporeactive) and Intolerant of certain sounds, smells, or textures N/A
sensory interests Fascination with certain forms of sensory input (e.g., captivated by light,
movement, and other visual effects; continually smelling or feeling objects)
Unreactive to sensory input (e.g., pain, temperature).
Visual fascination with lights or movement

Source: American Psychological Association (2013).

Stereotyped Behavior
As indicated in Table 2.7, ritualistic behaviors can dominate the social and communicative behavior of
individuals with autism, although they are manifested in divergent ways. Body movements, vocalizations, and
verbalizations can be self-stimulatory rituals, which may serve as a response or a way to manage aspects of the
environment (Baker, Lane, Angley, & Young, 2008). Movement rituals are varied and include rocking,
jumping in place, flapping arms, or staring at fingers in specific positions. Vocal rituals may include unusual
sounds or nonsense words.

Focused Interests
Communication patterns can be dominated by singular (i.e., restricted or circumscribed) interests and rituals
(Lam, Bodfish, & Piven, 2008). For example, some individuals with autism respond only if the cues and
prompts are precisely the same. Some people with autism engage in repetitive speech where they perseverate
on the same words or phrases, repeatedly asking the same questions and needing a specific answer, whereas
others may engage in the same familiar topic or conversation repeatedly. Some people with autism may
continually talk or write about a preferred object or activity, or they may become intensely interested in one
specific person and direct most of their interactions toward that individual.

Desire for Sameness

Individuals with autism can have a strong preference for routines (Szatmari et al., 2006). Routines can be
described as observable, repetitive behaviors that occur with predictable regularity (e.g., daily/weekly) and have
an interactive quality (Sytsma, Kelley, & Wymer, 2001). Routines provide order, structure, and predictability
and help to manage disorganization and anxiety. For individuals with autism, it can be very distressing when
changes occur and/or a routine is disrupted. Some people with autism adhere to strict daily schedules, have
restricted food preferences, insist on specific clothing, or demand that personal possessions be organized in a
highly restricted way. For some, minor changes such as a transition between two activities can trigger the
onset of repetitive behavior; for others, major events like holidays create unexpected changes and increase the
likelihood that intense ritualistic behavior will occur. Dependence on routines can increase during times of
change, stress, or illness, and the routines may become more intense or elaborate at these times (Stoppelbein,
Biasini, Pennick, & Greening, 2016).

Rituals
Rituals can reflect limited skills or be an attempt to create order in a confusing social environment. Studies
have shown that anxiety and ritualistic behavior can be linked in autism. For example, for some with autism, a
negative reinforcement relationship may be established between levels of distress and engagement in restricted
behaviors such that engagement in the distracting rituals reduces the negative valence of the anxiety, causing
maintenance or increases in the restricted behavior over time (Spiker, Lin, Van Dyke, & Wood, 2012). In
other words, the ritual can help to ease or provide a distraction from the anxiety and is therefore maintained or
reinforced as a behavior. Rituals can take a variety of forms. As described earlier in this chapter, play patterns
can be intensely ritualized and involve preoccupation with the same toy, object, or movie (Yanerys,
Lazarchick, Rooker, & DeLeon, 2013). Idiosyncratic thematic rituals are manifestations of an abnormally
intense interest in things like bus or train schedules or historical dates (Baker, 2000). Personal collections can
be organized incessantly, resulting in an unlimited supply of the same restaurant menu or movie schedule that
no one else is allowed to touch. These atypical, intense interests can interfere with most other social
interactions.

Reaction to Sensory Environmental Input

Some people with autism experience atypical responses to sensory input in the environment. One explanation
for ritualistic behavior states that some of the rituals seen in autism are a means for the individual to regulate
sensory stimulation (Boyd, McBee, Holtzclaw, Baranek, & Bodfish, 2009; Chen, Rodgers, & McConachie,
2009; Leekam, Prior, & Uljarevic, 2011). Repetitive motor patterns can be an attempt to seek sensory input

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(e.g., rocking may be a way to stimulate the vestibular system, lining up objects may provide visual
stimulation). Rituals can be used to gain access to visual, auditory, tactile, and vestibular stimulation that is
pleasurable and help the individual to relax. Similarly, they can be an attempt to reduce sensory input that is
overwhelming and uncomfortable (e.g., focusing on one select sound to tune out multiple distressing sounds).
The ritualized behavior that provides visual, auditory, gustatory, olfactory, tactile, or kinesthetic comfort is
reinforced and repeated over time.

Reasons for Restricted, Repetitive Behavior

Firsthand accounts given by people with autism provide some insight into restricted, repetitive patterns of
behavior (Grandin, 2009). Adults with autism have described their ritualistic behavior as a strong internal
drive, a pleasurable experience, or a means to compensate for an overstimulating sensory environment. As an
adult with autism, Barron described his childhood experiences with rituals: “I loved repetition. Every time I
turned on a light I knew what would happen. When I flipped a switch, the light went on. It gave me a
wonderful feeling of security because it was exactly the same each time” (Barron & Barron, 1992, p. 143).
Restricted and repetitive patterns of behavior may reflect the individual’s emotional state or
understanding. They are an expression of enjoyment for some and fear or anxiety for others. Fears can, in fact,
become ritualized. Individuals can make negative associations between a fearful event and an unrelated person
or object and develop ritualized panic reactions. Even self-injurious behavior can begin as a fear response and
gradually become a ritualistic behavior. Virtually every area of learning, socialization, communication, and
behavior can have ritualistic elements. Although repetitive behavior varies from person to person, there are
some general theories or schools of thought regarding the origin of ritualistic behavior (Troyb et al., 2016):
• Rituals are a means to regulate sensory stimulation.
• Rituals are an expression of emotion, specifically, anxiety.
• Rituals are a manifestation of impaired cognitive functioning.
• Rituals are an expression of poor inhibition, a neurological impairment.
As stated in the previous section, rituals may be a means for the individual to seek or reduce sensory input
due to overarousal or understimulation in unstructured environments (Ray-Subramanian & Weismer, 2012).
Another school of thought suggests that ritualistic behavior is an expression of anxiety and a means for the
person with autism to deal with the stress of perceived social chaos. Difficulty understanding social
information can result in experiencing the world as chaotic and frightening, thus contributing to anxiety.
Repetitive patterns may provide structure, order, and predictability, helping those with autism to cope with
the uncertainties of daily life.
Another theory suggests that ritualized patterns of behavior are associated with cognitive function (Bishop
et al., 2006; Kim & Lord, 2010; Militerni, Bravaccio, Falco, Fico, & Palermo, 2002). Difficulties in attention,
information processing, central coherence, social understanding, and executive functioning can all contribute
to ritualized behavior. The cognitive inability to shift mental focus and generate novel patterns of behavior
results in the individual’s becoming locked in routinized patterns. This cognitive inability contributes to
challenges with transitions and change in routines. With mindblindness, an individual with autism does not
understand that other people do not share the same thoughts, routines, or strong interests. This contributes to
one-sided, perseverative social interactions.
A final explanation is that the routinized behaviors in autism are an expression of poor inhibition and have
a neurological basis. Similarities between ritualistic behavior in autism and obsessive-compulsive disorder have
been found (Ruzzano, Borsboom, & Geurts, 2015; Zandt, Prior, & Kyrios, 2007). Research has found that
ritualized behaviors may function as a way to cope with anxiety, prevent changes, maintain interactions, or
express excitement, with significant variability across people with autism (Spiker et al., 2012). When rituals
are interrupted, some people with autism have no difficulty whereas others become agitated. The rituals in
which individuals with autism engage are almost limitless.
Everyone has interests, and most people prefer the comfort of physical, social, and conversational routines
in their lives. However, the intensity and duration of the restricted interest or repetitive pattern, along with
the person’s emotional reaction to terminating the behavior or activity, characterize rituals in autism. The
following are important questions to consider when assessing the impact of restricted, repetitive, ritualized
behaviors:
• Do the behaviors have a negative impact on learning?
• Do the behaviors limit the child’s level of independence in daily social activities?

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• Do the behaviors cause significant disruption to other people (e.g., family members)?
• Does the child appear distressed when engaging in the behavior?
• Does the child become more distressed when told to stop the behavior?
• Can the child stop the behavior independently? (Clements & Zarkowska, 2000)
The following vignettes illustrate ritualistic behaviors in children with autism.

Gary has learned the names of body parts through a book with an accompanying song. Gary enjoys looking at the book,
listening to the song, and touching the body parts named. He also enjoys listening to the song and following directions
from a puppet used by his mother. Whenever the puppet instructs him to touch a body part that is not a part of the
original book, Gary screams. He has generalized the activity to new materials, but the specific body parts that he
associates with the song have to stay the same.

Matt insists that objects in his house remain in the same place. One day, Matt’s aunt was visiting and having tea
with his mother. Matt’s mother had tea with milk; his aunt had plain tea. Matt asked his mother for milk. She poured
him a glass of milk, and he turned to pour it in his aunt’s cup. His mother said, “No.” Matt then began to scream,
pointed to the teacup, yelled, “MILK,” and began to cry. When his aunt handed him her teacup, he quickly calmed
down, poured some milk into her cup until it looked the same as his mother’s, and happily walked away.

Caroline’s rituals are marked by her insistence that the daily routine be predictable. Caroline becomes extremely upset
when certain events interrupt the routine. Examples include when her teacher is absent, when Friday’s normal school
lunch (e.g., pizza) is not offered, or when her mother stops on the drive home from school to run an errand.

Michelle has been collecting and carrying red objects since she was a toddler. On her first day of kindergarten, she
arrived at school carrying a large red bag full of red objects. In addition, her attention was fixated on all red things in
the classroom. She would scream when stopped from gaining access to anything red in the room, regardless of location or
ownership. It took a year for her to accept the school rule that she could carry only one red item.

Linda never used her left hand for anything other than carrying a blue miniature toy with her at all times. Previous
efforts to remove the blue toy resulted in days of panic and refusals to eat and sleep. Only when a lovely blue box that
played soft music was placed near her—to hold her blue toy—was Linda gradually able to let go of the toy for
increasing periods of time. As long as she could see her toy, she was calm. Linda’s interest in blue miniatures gradually
evolved into a lovely collection of pretty blue boxes that contain beautiful and unusual blue items.

Mia’s teacher has 15 colorful cards hanging in the classroom that define social terms in concrete ways. For example,
cope means “try three more times, then ask for help”; change means “I don’t know what is next”; and patience means
“use the relaxation procedure while waiting.” When Mia was asked which of the social rule cards was easy to follow,
she looked at the cards for a long time and then replied, “Cope.” When Mia was asked which of the social rule cards was
difficult to follow, she immediately replied, “Change; I don’t like change.”

SUMMARY
Autism manifests in diverse ways and must be viewed within the context of typical development, in which all
areas of development interweave to form a tapestry. This chapter illustrates typical development in nonverbal,
imitation, social, and communication skills. Cognition, language, socialization, communication, and
emotional development interface in intricate ways in a typically developing child.
Nonverbal core skill development is fundamental for the emergence of all social and communication skills.
Without nonverbal interaction, imitation, and organizational skills, individuals lack the ability to observe,
understand, and functionally utilize social information. Children first acquire nonverbal means of interaction,
such as gestures and eye gaze. Success with nonverbal communication eventually can lead to an emergent
understanding and use of language as a tool for social interaction. Verbal as well as nonverbal communicators
need to be firmly grounded in all core skill areas. Core skills foster social awareness, which is key to higher
interactive skills such as conversation and social participation in community outings.
Social activities are complex and constantly changing. To engage in social interaction, a person needs to
feel organized and motivated. Virtually every social situation requires the ability to know what to do and how
to watch, listen, and/or communicate with others while engaged in an activity. Social skills intervention
should help children and adolescents with autism coordinate what to DO, whom to WATCH, how to
LISTEN, and what to SAY in a variety of social situations.

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 Communication is equally complex and dynamic, requiring active reciprocal interaction. To be an effective
communicator, an individual must be socially motivated and have a means of communication and a reason to
communicate. Communication (i.e., what to SAY) is more likely to occur in those social contexts in which the
individual knows what to DO, whom to WATCH, and how to LISTEN during an interaction. Although
there are many intervention resources available to teach the acquisition of language, most of them assume that
functional communication will occur automatically. Given the nature of autism, communication skills need to
be addressed systematically.
The scientific literature of the past decade has shed light on the complexity of autism. Nevertheless, those
of us who have lived or worked with youth with autism recognize that the research does not fully capture,
explain, or do justice to the diversity of the spectrum. The autism continuum is broad and contains many
unknowns. The various behaviors of people with autism are constantly challenging what specialists think they
know about the disorder. Assessment and intervention, which are addressed in the following chapters, must
take into account each child’s unique learning style and social perspective so that he or she can successfully
build skills and meaningful relationships. A complex disorder requires complex solutions. The challenge for
educators and families is to respect the child’s struggles with social and communication skills while trying to
build success in those areas. This challenge is important to the continued pursuit of understanding autism and
is humbling to those who dedicate their lives to helping individuals on the spectrum.

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 CHAPTER 3

Assessing Social and Communication Skills

LEARNING GOALS:
1. Describe the comprehensive assessment process to identify social and communication challenges in
children and youth with autism spectrum disorder.
• Describe purposes of educational assessment.
• Understand terms used to describe assessments: formal or informal, standardized or nonstandardized,
norm-referenced or criterion-referenced, quantitative or qualitative.
• Summarize screening instruments and assessment tools currently available to evaluate social and/or
communication skills.
• Describe how the Assessment of Social and Communication Skills for Individuals with Autism Spectrum
Disorder, Revised (ASCS-2) can be used for intervention planning and progress monitoring.
• Understand how to administer and score the Assessment of Social and Communication Skills for
Individuals with Autism Spectrum Disorder, Revised (ASCS-2).

P rofessionals face specific challenges when assessing social and communication abilities in children and
young people with autism. These include determining which assessments provide useful information
and accommodating for the child’s atypical patterns of development in the assessment process. The
purpose of this chapter is twofold: 1) to summarize the formal and informal assessments currently available to
evaluate social and/or communication development and 2) to describe an updated comprehensive assessment
of social and communication skills that is specifically designed for children and youth with autism. We begin
with an overview of the diagnostic tools and developmentally based curriculum assessments used to evaluate
social and/or communication skills, and then we outline the rationale and use of the Assessment of Social and
Communication Skills for Individuals with Autism Spectrum Disorder, Revised (ASCS-2). This tool fills some
current gaps in the field and addresses key challenges in assessing social and communication skills in children
and youth with autism. See the Chapter 3 Appendix or visit brookespublishing.com/downloads for the full
assessment.

UNDERSTANDING EDUCATIONAL ASSESSMENTS

Educational assessments serve three basic purposes, which are to 1) provide an estimate of developmental
functioning, 2) describe and pinpoint those skills in need of intervention planning, and 3) document
development and progress over time. The two basic kinds of assessment instruments are formal tests and
informal assessments. Terms used to describe formal and informal assessment instruments are standardized or
nonstandardized, norm-referenced or criterion-referenced, and quantitative or qualitative. Both formal and
informal types of measures are used to evaluate children with autism. There is a broad range of assessment
options for interventionists, each with benefits and limitations. Formal, standardized tools have clear benefits
of measured validity and reliability yet are often limited in their direct application to curriculum and
instruction planning. Informal, criterion-referenced tools have the greatest utility for intervention planning
and skills tracking.

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 Formal assessments are standardized and norm-referenced. Formal assessments are administered in a
prescribed way and provide a summary of quantitative (i.e., measurable and numeric) scores. These types of
tests are typically based on developmental sequences and describe a child’s performance relative to a normative
sample. For example, a standardized evaluation instrument may report a standard score, a percentile, a
standard deviation, or an algorithm with cutoff scores, comparing a child’s current level of performance to
same-age peers. Examples of norm-referenced assessments include intelligence (IQ) tests, academic
achievement tests, and standardized measures of development (e.g., language, motor). Although formal
assessments provide a quantitative measure of developmental functioning and can document general
developmental progress over time, these instruments do not typically describe specific skills to target in
intervention.
In contrast, informal assessments are nonstandardized and are criterion-referenced. An individual’s
performance is not compared with others but, rather, is used to design an intervention plan. For example,
criterion-referenced assessments are designed to measure an individual’s performance against a fixed set of
predetermined criteria or learning standards. Informal assessment tools provide a profile of mastered skills and
a list of skills to target for intervention. The skill profile is used to determine instructional goals and to
document progress. Some informal assessments measure abilities directly, via observation or direct sampling of
skills in natural contexts. Other informal tools—such as inventories, questionnaires, rating scales, and
checklists—measure ability indirectly by interviewing others familiar with the child. These assessments
generally provide qualitative results that can be directly linked to intervention.
Even though informal assessments do not yield standardized developmental information, these
instruments provide an estimate of developmental functioning and guidance to design an individualized
education program (IEP). Informal assessments help to identify specific skills needed for intervention and can
be used to systematically document development and progress over time.

ASSESSMENT OF SOCIAL AND COMMUNICATION SKILLS IN

AUTISM
There are a number of formal and informal measures that are commonly used to diagnose children with
autism, assess their social and communication development, and/or identify intervention needs. Although
formal assessments provide a snapshot of social and communication development, a number of disadvantages
exist when using these instruments to evaluate children with autism:
1. The qualities of social and communication behavior in autism are not adequately represented by
standardized measures. Development of social and communication skills in children with autism often
follows a path that diverges from that in typically developing children. Children with autism may acquire
skills in different sequences, use skills in idiosyncratic ways, or demonstrate unusual compensatory skills.
Atypical developmental patterns make it difficult to translate standardized assessments into meaningful
intervention programs.
2. A child with autism may demonstrate a particular skill in the natural environment but may not be able to
perform the same skill under controlled test situations. As a result, norm-referenced tests may limit the
scope of information obtained for planning instruction.
3. Given that impairments in social and communication development are central to autism, the
measurement of these skills needs to be a priority in assessment and intervention.
As a result, the majority of assessment tools to measure social and communication development in autism
are informal tools designed to identify developmental strengths and weaknesses and aid in the development of
an intervention plan.
There are many assessments used to identify children with autism and/or assess their social and
communication development, including
• Screening and diagnostic instruments
• Adaptive behavior scales
• Social assessments
• Communication and pragmatic assessments
• Curriculum-based assessments

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Screening and Diagnostic Instruments
The diagnostic criteria for autism spectrum disorder are largely linked to the presence or absence of social and
communication milestones. As such, many assessment tools that address social and communication skills have
been designed for screening and diagnostic purposes. A number of diagnostic tools rate the degree of social,
communicative, and behavioral challenges in children with autism. Table 3.1 summarizes the most common
diagnostic and screening instruments. Many of these diagnostic tools have proven reliable in determining
whether or not a person has autism. They also provide a structured means to record general diagnostic
information and are used frequently in clinical research.

Table 3.1. Diagnostic and screening instruments

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Adaptive Behavior Scales
Adaptive behavior scales are formal, standardized instruments and give a general measure of developmental
functioning, which includes, but is not limited to, social and language development. These assessments are
commonly used to assess children with a wide variety of developmental disorders. Table 3.2 summarizes three

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standardized adaptive behavior scales that are commonly used to evaluate adaptive behaviors in children with
autism.

Table 3.2. Adaptive behavior scales

Name of assessment Tool description Areas measured
Vineland Adaptive Behavior Scales, Third Edition A standardized tool designed to use interviews and questionnaires to obtain general social, Social skills
(Sparrow, Cichetti, & Saulnier, 2016) communication, self-care, motor, and behavioral developmental indices for ages birth to adulthood. Communication skills
Self-care skills
Motor skills
Behavior
Adaptive Behavior Assessment System, Third Edition A standardized tool designed to provide a complete assessment of adaptive skills across the lifespan, Assesses 11 skill areas within three
(ABAS-3; Harrison & Oakland, 2015) from birth to 89 years. Consists of a rating scale typically completed by parent, caregiver, and/or adaptive domains:
teacher, with a self-rating option for adults. Conceptual
Social
Practical
The Behavior Rating Inventory of Executive Function A standardized tool designed to identify individuals at risk for eight measures of executive Inhibit
(BRIEF; Gioia, Isquith, Guy, & Kenworthy, 2013) functioning, all of which impact every aspect of social and academic functioning for ages 5–18 Shift
years. There are 86 items in the questionnaires, and checklists assess eight measures of executive Emotional control
functioning. The tool consists of teacher and parent versions. Initiate
Working memory
Plan
Organize materials
Self-monitor

Social Assessments
The majority of social assessments are not standardized and most are designed to examine one area of
development, such as play or social perspective taking. Some assessments are designed to measure overall
social developmental competence. Other assessments examine social skills for intervention planning. Table 3.3
provides an overview of social assessments that can be used to evaluate various aspects of social functioning.

Table 3.3. Social assessments

Name of assessment Tool description Areas measured
Social Skills Improvement System Rating Scales (SSIS; A standardized tool designed to measure a range of social skills, competing problem behaviors, and Social skills
Gresham & Elliott, 2008) academic motivation for ages 3–18 years. This is a multi-rater tool. Problem behaviors
Academic competence
The Social Skills Rating System (SSRS; Gresham & Elliot, A standardized tool designed to obtain a general social competence score by rating various social skills Social skills
1990) on a Likert scale (Never-to-Always). A reliable and valid measure for assessing the social Problem behaviors
competence of students in preschool, elementary school, and secondary school. Academic competence
TRIAD Social Skills Assessment (Stone, Ruble, Coonrod, A tool designed to assess knowledge and skills in three social areas: Cognitive, behavioral, and Cognitive: Understand others’
Hepburn, Pennington, Burnette, & Brigham, 2010) affective. The tool is for intervention planning for verbal children ages 6–12 years who have first perspectives
TRIAD = Vanderbilt Treatment and Research Institute for grade–level reading skills. It is criterion based, and information is gathered through parent and Behavioral: Initiate and maintain
Autism Spectrum Disorders teacher interview and direct sampling of skills. interactions
Affective: Understand basic and
complex emotions
Autism Social Skills Profile (Bellini, 2006) A criterion-based tool designed for intervention planning in which family members and Social
interventionists rate a student’s skills and behaviors in social situations. There are 49 items rated on
a 4-point Likert scale based upon how often the skill is observed and whether the skill is present
without assistance from others.
The Scale for Assessing Development of Children’s Play A tool designed to measure spontaneous play activities and the developmental elements of play in Features of play
(Westby, 2000). young children.
The Integrated Play Group Assessment, Second Edition A tool designed to assess and monitor the cognitive, communication, and social dimensions of play Cognitive
(IPG; Wolfberg, 2009) behaviors in children with autism. It is based on a prescribed intervention model of the same name, Communication
integrated play groups (IPGs). The informal assessment is used to obtain a baseline, design Social dimensions of play
integrated play groups, and monitor intervention effectiveness. There is growing evidence
validating the efficacy of the IPG model to promote play in children with autism.
False Belief Test (Baron-Cohen et al., 1985) A tool designed to assess a core aspect of social cognition: theory of mind. In a series of tasks, children Theory of mind
watch and hear a scenario about two characters and are asked to predict one character’s behavior;
(i.e., “I think she knows _____” or “I think she feels _____”). The test requires one to consider the
scene from the character’s perspective.

Communication Assessments
Communication assessments have been developed to examine distinct skill sets: prelinguistic communication
skills, the social functions of communication, and social-pragmatic skills. Much attention has been given to
developing measures that examine prelinguistic social and communicative skills in young children—the key to
early identification of autism. Assessing the social functions of communication contributes to our
understanding of the atypical language and communication patterns observed in autism, and expanding
functional communication is a critical piece of intervention. Table 3.4 presents some commonly used informal
measures of prelinguistic communication skills and the social functions of communication.

Table 3.4. Communication assessments

Name of assessment Tool description Areas measured
Communication and Symbolic Behavior Scales (CSBS) and A tool designed to examine early social-communicative and symbolic skills across various Gestural communication
Communication and Symbolic Behavior Developmental communicative contexts. CSBS is intended for children whose functional communication is Vocal communicative means
Profile (CSBS DP) (Wetherby & Prizant, 1993, 2002) between 8 and 24 months of age. The CSBS DP is a checklist to screen children at 1-year well- Reciprocity
baby medical check-ups and is based on both parent report and face-to-face evaluation. The tool Affective signaling
provides a starting point for planning IFSPs, identifying areas for further assessment, determining Symbolic behaviors
the efficacy of interventions, and documenting changes in behavior over time.
Functional Communication Profile, Revised (FCP-R; A tool specifically designed for students with moderate to severe developmental delays. The FCP-R Attentiveness
Kleiman, 2003) yields an overall inventory of the individual’s communication abilities, mode of communication Non–oral communication
(e.g., verbal, sign, nonverbal, augmentative), and degree of independence. Information is gathered Comprehension
through direct observation, teacher and caregiver reports, and one-to-one testing. There are 10 Use of various symbol systems
subscales related to communication. Pragmatics (e.g., communicative intent
and conversational skills)
The Social Communication Questionnaire (SCQ; Rutter, A standardized parent report tool designed to assess children with autism over the age of 4 years with Communication
Bailey, Lord, & Berument, 2003) a mental age over 2 years. There are 40 yes/no items, which can be completed in less than 10 Social functioning
minutes by a parent or other caregiver. The tool can guide general intervention recommendations. Restricted, repetitive, and stereotyped
There are two versions: current and lifetime. patterns of behavior

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 In addition to the informal communication tools, assessment of more advanced pragmatic skills is
included in a few, but not most, formal language assessments. Most standardized language assessments focus
on the structural aspects of language acquisition and fail to address social pragmatic skills in detail. Table 3.5
highlights assessments that do contain some elements of pragmatic development. All of the tools are
standardized and provide a general measure of pragmatic competence relative to same-age peers.

Table 3.5. Pragmatic skills assessments

Name of assessment Tool description Areas measured
Clinical Evaluation of Language Fundamentals, Fifth A standardized tool that includes two tests that are designed to assess pragmatics in ages 5–21 years. Assesses social communication
Edition (CELF-5) Pragmatic Profile and Pragmatic These observation- and interaction-based assessments evaluate social communication language language skills
Activities Checklist (Wiig, Semel, & Secord, 2013) skills. The Pragmatic Profile is a checklist for rating verbal and nonverbal pragmatic skills and is
supplemented with the Pragmatic Activities Checklist, which is used to observe target pragmatic
skills in three social interaction activities. Sample items include following conversational rules,
understanding humor/jokes, understanding and expressing complex intentions, and awareness/use
of prosodic cues. The profile tool easily translates into specific intervention goals for individuals
with complex language skills.
Test of Pragmatic Language, Second Edition (TOPL-2; A standardized tool designed to analyze social communication in context. Its principal uses include 1) Assesses underlying pragmatic
Phelps-Terasaki & Phelps-Gunn, 2007) identifying individuals with pragmatic language deficits, 2) determining individual strengths and language skills
weaknesses, 3) documenting an individual’s progress, and 4) researching pragmatic language skills.
• There are 43 items on version of assessment for ages 8–18 years.
• There are 17 items on version of assessment for ages 6 and 7 years.
Test of Problem Solving (TOPS; Bowers, Huisingh, A standardized test designed to assess problem solving and critical thinking based on the individual’s Assesses language-based thinking
Barrett, Orman, & LoGiudice, 1994; Bowers, Huisingh, language strategies, logic, and experiences. There are several versions. abilities and strategies using logic
& LoGiudice, 2005; 2007) • TOPS 2 Adolescent: Ages 12–17 years and experience
• TOPS 3 Elementary: Ages 6–11 years
The test is a series of photographs that cover issues such as making inferences, problem solving,
sequencing, negative questions, predicting, determining causes, determining solutions, interpreting
perspectives, and transferring insights. To assess, ask individuals questions about the series of
photographs.

Curriculum-Based Assessments
Curriculum-based assessments are informal, criterion-referenced tools that help design and monitor
intervention plans for children and youth with various special needs. The most commonly used today are
those designed by behavior analysts and developed predominantly for children with autism. These assessments
are used to track acquisition of discrete skills, with less attention given to the functional use of skills in the
natural environment. In contrast, other intervention-based developmental assessments are not specifically
designed for children with autism and do not address the wide range of specific social and communication
skills needed for effective instructional planning and monitoring. Table 3.6 summarizes key curriculum-based
assessments.

Table 3.6. Curriculum-based assessments

Name of assessment Tool description Areas measured
Brigance Inventory of Early Development III (Curriculum A criterion-referenced and a norm-referenced standardized tool designed to assess young and school- Assesses physical development,
Associates, 2012, 2013) age children under the developmental age of 8 years. The data can guide planning, implementation, language development, literacy,
and progress monitoring of curriculum and instruction. mathematics and science, daily
living, and social-emotional
development.
Brigance Transition Skills Inventory (Curriculum A curriculum-based, criterion-referenced tool designed to assess adolescents and young adults. Assesses independent living,
Associates, 2010) Assesses skills to support transition planning for middle and high schoolers. employment, and post-secondary
skills to support transition planning.
Assessment of Basic Language and Learning Skills, Revised A curriculum-based, criterion-referenced tool and skill tracking system designed to provide a Assesses more than 500 developmental
(ABLLS-R; Partington, 2006) comprehensive review of more than 500 skills in all developmental areas, including language, social, skills in all areas
early academic, and motor skills. It serves as a reliable means to generate highly specific
intervention objectives and monitor progress.
Verbal Behavior Milestones Assessment and Placement A curriculum-based assessment tool designed to track skill development based on established Assesses 170 language and social
Program (VB-MAPP; Sundberg, 2008) developmental milestones (0–48 months) and research from the field of behavior analysis. The VB- milestones as well as 24 potential
MAPP has been field-tested with autism. Considered the gold-standard measurement of critical language and learning barriers.
skills for early language and learning.

THE ASSESSMENT OF SOCIAL AND COMMUNICATION SKILLS

FOR INDIVIDUALS WITH AUTISM SPECTRUM DISORDER,
REVISED (ASCS-2)
The ASCS-2 is a criterion-referenced, nonstandardized tool designed to assess social and communication
skills in children and youth with autism and to assist in intervention planning. This assessment is an updated
and revised version of the Assessment of Social and Communication Skills for Children with Autism, which was
developed in 2000. Revisions to the tool are based on 15 years of use and feedback from educators and
clinicians. The ASCS-2 maintains the basic structure of this original assessment but with a number of
additions, changes, and improvements.
The ASCS-2 is structured so that it can be used to assess individuals of all ages and all developmental
levels and was developed for professionals who are responsible for the evaluation, intervention planning, and
progress monitoring of social and communication skills. It can be used along with other formal and informal
social and language assessment instruments to obtain a complete evaluation of an individual’s social and
communication competencies and to design intervention. Specifically, the ASCS-2 allows the educational
team to

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• Profile a child’s social and communication strengths and areas of need
• Identify obstacles that impede the child’s acquisition, mastery, and functional generalized use of social and
communication skills
• Prioritize intervention goals and objectives
• Provide a detailed record of a child’s social and communication skills over time
• Determine which acquired skills are generalized and functional
• Monitor progress over time
The ASCS-2 is divided into three separate assessments that can be used individually or in any
combination. The three assessments are
1. ASCS-2 Behavior Profile: This questionnaire profiles the child’s general social and communication abilities
and is used to generate a qualitative overview of the child’s current skills.
2. ASCS-2 Obstacles Questionnaire: This questionnaire measures obstacles to learning and independent
functioning, including the child’s level of social motivation; sensory sensitivities; prompt dependency; and
restricted, repetitive, and other challenging behaviors. This portion of the ASCS-2 yields a quantitative
measure of obstacles and provides space for the evaluator to write a qualitative overview of the individual’s
major obstacles to social and communication development and independence.
3. ASCS-2 Skills Checklist: This checklist measures skill levels for a range of social and communication skills
in four areas: Core Skills, Social Skills, Communication Skills, and Community Skills. These four
separate checklists are further subdivided into domains, with each assessing a number of discrete skills.
The goal of the ASCS-2 Skills Checklist is to measure functional, generalized skill use. There is a new
coding system for measuring an individual’s level of skill acquisition, which includes four levels:
• Absent = Skills rarely evident or never observed
• Emerging = Skills acquired through direct instruction but observed only in one context, used with or
without prompts
• Mastered = Skills acquired through direct instruction but observed only in contexts that have been
targeted for instruction, used without prompts
• Generalized = Skills used independently and applied functionally across both instructional and
noninstructional settings
Each individual ASCS-2 assessment includes an assessment summary, which allows the evaluator to
examine the most pertinent pieces of collected data in a flexible manner to plan programming and monitor
progress. A narrative summary is generated from the ASCS-2 Behavior Profile, and data from the ASCS-2
Obstacles Questionnaire and ASCS-2 Skills Checklist are transferred onto a summary form and scored. The
ASCS-2 may be administered once to gather information or multiple times over a period of years to monitor
long-term progress on skills. For the ASCS-2 Obstacles Questionnaire and ASCS-2 Skills Checklist, there is
the option to record data from three separate administrations of the assessments on a single progress
monitoring form. Both the ASCS-2 Obstacles Questionnaire and ASCS-2 Skills Checklist also contain
program planning forms for generating a list of specific instructional objectives based on the data collected
during assessment.
The sections that follow discuss the rationale for designing the ASCS-2, the format of the assessment, and
administration guidelines. Examples of how to administer and score the ASCS-2 are explained through the
use of case examples. For the full ASCS-2 assessment, see the Appendix to this chapter or download it at
brookespublishing.com/downloads.

ASCS-2 Rationale
There is a broad range of assessment options for interventionists, each with benefits and limitations. For
children and youth with autism, the popularity of tools such as the Assessment of Basic Language and
Learning Skills (ABLLS; Partington, 2006) and the Verbal Behavior Milestones Assessment and Placement
Program (VB-MAPP; Sundberg, 2008) is due, in large part, to the precise measurement of target skills and
rigor of progress monitoring. Still, there are gaps in these assessment options that are addressed in the ASCS-
2.
The ASCS-2 was created with an understanding of the importance of core social and communication

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skills, key skills of executive functioning and social cognition, and building functional, generalized skill use.
The ASCS-2 includes
• An expanded focus on critical core skills of joint attention, imitation, and self-regulation
• A broader range of functional social and communication skills, specifically in the areas of executive
functioning and social cognition, that are not explicitly addressed in other widely used developmental
scales or intervention tools
• A measured distinction between skill mastery and skill generalization

Importance of Core Skills Research evidence points to the importance of identifying core social and
communication skills and behavioral obstacles to learning. Comprehensive assessments must focus attention
on these essential skills. Studies of early indices and long-term outcomes reveal that assessment of children
with autism needs to focus on observed social features, restricted and repetitive behaviors, and level of
communication (Lord, 2010). Specifically, spontaneous communication, response to joint attention, and the
initiating of joint attention all are core skills that contribute to long-term social and communication outcomes
(Kasari, Gulsrud, Freeman, Paparella, & Hellemann, 2012; Toth, Munson, Meltzoff, & Dawson, 2006). The
presence and severity of restricted and repetitive behaviors during social interaction are also significant
predictors. The ASCS-2 profiles a child’s restricted and repetitive behavior and measures a range of critical
core skills that aligns with both autism screening tools and the diagnostic criteria in the American Psychiatric
Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; APA, 2013).

Importance of Executive Functioning and Social Cognition The original Assessment of Social and
Communication Skills for Children with Autism (Quill, 2000) has been used worldwide. Interventionists
provided feedback on its functional utility over time. Based on extensive reviews, changes were made to that
assessment to create the ASCS-2, which includes a wider range of functional skills that are not explicitly
addressed in other developmental scales or intervention tools. The addition of self-regulation skills and social
perspective-taking skills draws from the growing body of research on social cognition and executive
functioning skills in autism. Specific attention was given to organizational skills as core measures of self-
regulation and executive functioning. The ASCS-2 checklists were expanded to include functional measures
of social perspective taking, emotional understanding, and friendships.

Importance of Generalization The severity of autism may be related to the individual’s inability to
generalize social and communication skills after direct instruction (Quill, 2004). Because generalization often
does not naturally occur in autism, comprehensive assessments must explicitly distinguish between skill
mastery and functional skill use (i.e., generalization). In general terms, mastery refers to the ability to
demonstrate a skill, whereas generalization is the ability to extend and apply that skill to a variety of natural
contexts. A measured, clear distinction between skill mastery and skill generalization is a key feature of the
ASCS-2 in both assessment scoring and progress monitoring.
• Mastery is demonstration of skills through direct instruction in structured, contrived, and/or natural
settings.
• Functional generalization is spontaneous, novel demonstration of skills in natural settings without direct
instruction.
Criterion-referenced curriculum assessments do not make this subtle but important distinction between
mastery and functional use. The definition of skill mastery within most assessments is typically the same
across all developmental areas assessed (i.e., mastery of language, academics, or social skills). Other assessment
instruments do not explicitly capture the challenges that children with autism have with generalization of
social and communication skills. The ASCS-2 is structured to systematically and quantitatively measure and
monitor the acquisition, mastery, and functional generalization of social and communication skills in children
and youth with autism from ages 3 to 18 years.
It becomes the responsibility of the educational team to include the criteria for mastery and generalization
in the intervention plan. For example, a behavioral objective for skill mastery may be worded as “the child will
demonstrate ‘skill’ ‘under specific conditions’ in 8 of 10 measured opportunities” or “… in [specific number]
contexts.” Generalization to the natural environment is sometimes but not always embedded in the
operational definition of mastery. A behavioral objective for skill generalization may be worded as “The child
will demonstrate spontaneous skill use with novel adults and peers, and in noninstructional settings and
activities.”

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ASCS-2 Format
This section explains the format of the three separate assessments within the ASCS-2: 1) The ASCS-2
Behavior Profile, 2) The ASCS-2 Obstacles Questionnaire, and 3) the ASCS-2 Skills Checklist. As
mentioned previously, these assessments can be used separately, or an evaluator may elect to use all three
assessments for the most comprehensive view of the child’s abilities and needs.
I. ASCS-2 Behavior Profile The purpose of the ASCS-2 Behavior Profile is to
• Gather general information about the child’s current social and communication abilities, including
strengths and challenges
• Identify motivators that can have an impact on learning, including preferred social and communication
partners, activities, and interests
The Behavior Profile consists of questions in six areas:
1. Social and Communication Partners
2. Social Activities
3. Social Interactions
4. Communication Foundation
5. Communication Means
6. Communication Functions
The questionnaire elicits general information about the child’s social partners and leisure skills and the
conditions under which the child initiates interactions with others. It includes questions about how the child
communicates, with whom the child communicates, why the child communicates, and the conditions under
which the child communicates most effectively. The questionnaire solicits information on preferred social
partners/friends, preferred activities, and social interests that could provide opportunities for social and
communication enhancement. It also identifies 1) preferred settings in which the child is most socially
interactive and communicative and 2) reinforcing events that are more likely to elicit communication and
social interaction.
II. ASCS-2 Obstacles Questionnaire The purpose of the ASCS-2 Obstacles Questionnaire is to gather
essential information about the child’s restricted, repetitive, and other behavioral challenges that can interfere
with learning and serve as obstacles to socialization and communication. The Obstacles Questionnaire
examines six types of obstacles to independent functioning and learning, including
1. Social restricted and repetitive behaviors
2. Communication restricted and repetitive behaviors
3. Prompt dependency
4. Sensory challenges
5. Social motivation
6. Challenging behaviors
Each behavioral obstacle, if present, is rated as Mild, Moderate, or Significant. Obstacles are rated by the
degree to which the behavior interferes with social functioning, communication, independence, and learning.
The information collected through the ASCS-2 Obstacles Questionnaire is recorded and scored, yielding
both a numeric score and the option to generate a narrative summary of the child’s obstacles to learning and
independent functioning. The team uses the information to prioritize obstacles for intervention. The
Obstacles Program Planning Form is structured so that the team can 1) select specific behavioral obstacles for
intervention and 2) generate specific, measurable instructional objectives to decrease the severity of each
obstacle. Once restricted, repetitive, and other challenging behaviors are identified for intervention, then a
more detailed functional analysis of each behavioral obstacle should be conducted by the team. Progress in
reducing behavioral challenges and obstacles over time can also be tracked via the Obstacles Progress
Monitoring Form. This form provides space to record and calculate the numeric scores representing the
impact of behavioral obstacles for up to three assessments.
III. ASCS-2 Skills Checklist The purpose of the ASCS-2 Skills Checklist is to determine whether specific

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skills are in the child’s repertoire and whether each skill is absent (A), emerging (E), mastered (M), or
generalized (G). The Skills Checklist contains measures of social and communication competence in four
areas:
Part I. Core Skills
Part II. Social Skills
Part III. Communication Skills
Part IV. Community Skills (requires integration of core, social, and communication skills)
The Checklists contain the following skill domains:
• The Core Skills Checklist contains those core skills that lay the foundation for all social learning;
specifically, joint attention; nonverbal gestures; social awareness; motor imitation; verbal imitation;
organization of materials, time, and choices; and self-regulation, including emotional regulation and the
ability to navigate transitions.
• The Social Skills Checklist measures social competence; specifically, solitary play and leisure, social play
and leisure (e.g., structured and unstructured), group skills (e.g., attending, taking turns, and following
directions), and social perspective taking (e.g., emotional understanding, and friendships).
• The Communication Skills Checklist measures communication competence; specifically, basic
communication skills related to the social functions of communication (e.g., requesting, responding to
social overtures, answering questions, commenting, and asking questions or seeking information);
socioemotional skills that involve more complex expressions of emotional understanding (e.g., express basic
feelings, express complex feelings, and prosocial skills); and basic conversational skills (e.g., verbal
reciprocity, verbal discourse topics, and nonverbal conversation skills).
• The Community Skills Checklist examines skills needed for community outings; family outings; and
school, work, and safety situations.

The information collected and recorded on the ASCS-2 Skills Checklist is transferred onto a summary
form and/or a progress monitoring form. The ASCS-2 Checklist Summary Form is used to record the
number of Absent, Emerging, Mastered, and Generalized skills in each of the domains and to calculate the
percentage of Core, Social, Communication, and Community skills at each level of skill acquisition. There are
two progress monitoring forms that can be used to record the data and quantitatively track improvement over
time. Numeric data can be recorded for up to three consecutive assessments to measure progress, and/or
numeric data can be transferred onto a graphic form for a visual display of progress.
These data are then used for intervention planning based on the child’s profile, learning obstacles, and
current skills. The team prioritizes skills for intervention and writes objectives using the ASCS-2 Skills
Checklist Program Planning Form. One of the most important goals of the ASCS-2 Skills Checklist, and of
the ASCS-2 as a whole, is to make sure that the child is actually generalizing skills to novel contexts and is
able to use the skills independently in multiple settings and with multiple communication partners. The team
should have this goal in mind when selecting priority objectives. A variety of program implementation data
forms are available to monitor the acquisition, mastery, and generalization of skills over time (see Chapter 9).

General Guidelines for Administration and Data Collection

Careful data collection is an integral part of any assessment process. The ASCS-2 encourages the evaluator to
follow best practices and gather information from multiple sources including interviews, observations, and
direct sampling techniques.
• The first step is to obtain information about the child’s social and communication skills through a series of
structured interviews with two or more team and family members who are reliable informants.
• If there is uncertainty among the team about the presence of a specific skill or behavior, then the second
step is to conduct one or more observations during activities in which opportunities to demonstrate a
specific skill would naturally occur.
• If there are no opportunities to observe a specific skill in the natural setting, then the third step is to assess
the child through direct sampling techniques.
There is no time limit for completion of the entire assessment tool. The total time to complete the ASCS-
2 varies significantly and depends on the reliability of the informants and the number of observations and

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direct samplings required to obtain needed information. The evaluator and team can determine which settings
and activities are most likely to yield information about the child’s social and communication competence.
Observations and direct sampling can be conducted in school, home, and community settings. The ultimate
goal is to determine under which conditions the child is most socially engaged and communicative.
Interviews Interviews are an effective means to gather information, especially when used in conjunction
with observation and direct skill sampling procedures. Interviews provide a historical view of the child and an
understanding of the dynamic quality of the child’s social and communication skills. In addition, interviews
with family members, teachers, therapists, and others who know the child well are invaluable for discovering
how he or she functions in various social contexts over an extended period of time.
The ASCS-2 is designed so that all information can be gathered using an interview format. The ASCS-2
Behavior Profile and the Obstacles Questionnaire are formatted as a list of questions, and all items in the
ASCS-2 Skills Checklist can be phrased as questions. Structured interviews can be the primary source of
information if the evaluator is familiar with the child and has two or more reliable informants such as parents,
teachers, therapists, and behavior analysts. The extent and reliability of information increase with the use of
multiple informants.
It is recommended that the team work collaboratively in a group to share information and compare and
contrast the child’s skills across different settings. This interview format will glean insight into where and how
the child demonstrates a range of social and communication skills. If there is uncertainty among the team
about the presence of a specific skill, then the evaluator can use more direct ways to assess the child’s skill
level, which include 1) observation and 2) direct skill sampling.

Observations Any uncertainty about the child’s skills or the accuracy of information obtained through
interviews can be resolved through direct observations. Observations provide vital information about how the
child functions in his or her natural environment. For maximum effectiveness, multiple observations should
occur over a number of days, in multiple settings, and during various activities. Observations require the
evaluator to watch the child where opportunities to demonstrate specific skills will naturally occur. The
evaluator observes whether a target skill occurs spontaneously, without prompting. Observations provide
information about emerging skills (observed only in one setting) and mastered skills (observed in multiple
familiar settings). Generalization of skills can be determined only when the child is observed in novel settings,
in new activities, and with unfamiliar adults. When conducting observations, consider the following
guidelines:
• Observe in settings in which the child is motivated and focused, because ascertaining the conditions under
which he or she is most interactive is a critical part of the assessment process.
• Observe in settings in which the child is unmotivated or challenging behaviors occur to confirm the
current learning obstacles.
• Observe in settings in which there are opportunities for the child to interact with both familiar and
unfamiliar adults and peers. This will assist the evaluator in determining the degree to which the individual
is able to generalize skills across social settings and social partners.
When there are limited opportunities to observe in multiple settings, information can be collected through
video-recorded analysis of the child engaged in social activities with adults and peers. Revealing information
about the quality of a child’s nonverbal and verbal social and communication skills can be obtained through
recorded analyses of various interactions.
Although these observations are time consuming, the information generated provides a comprehensive
profile of the child’s functional social and communication skills. As you conduct the interviews and
observations, consider the possible impact of gender; socioeconomic status; and familial, cultural, and
linguistic diversity on both the child’s current social and communication skills and any decisions about
intervention priorities.
Direct Sampling of Skills Once the interview and observation processes are complete, there may be some
unanswered questions that require more direct sampling of specific skills with the child. Direct sampling
consists of setting up at least three different activities or situations to elicit a specific skill and recording the
individual’s ability to demonstrate the skill. Direct sampling should be done in at least two familiar activities
and one novel activity. The evaluator can interact directly with the child or coach a familiar adult through the
process of eliciting a target skill. The evaluator records the individual’s skill use, with or without prompting.
If the child demonstrates the skill through direct sampling, the responses provide information about the
presence of the skill. If elicited in only one setting, the skill is coded as an emerging skill. If elicited in three

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different settings or activities, it is coded as a mastered skill. The presence of the skill in one novel setting is
not a reliable measure of generalization. If there is any uncertainty about generalization, continue to sample
the target skill in multiple settings and across multiple adults and peers.
Before beginning the direct sampling, review the information in the ASCS-2 Behavior Profile to identify
interests and motivating activities that can be used to sample skills. Once activities and materials are
identified, skills can be systematically sampled by using
• Structured social opportunities
• Communication sabotage
Structured Social Opportunities The majority of social skills can be sampled using structured social
opportunities, which involves using toys, materials, and activities commonly found at home or school and
structuring the activity to elicit the skill in question. For example, one could set up a group game that requires
imitation to assess whether a child imitates peers. The sample activities and strategies described later in this
text provide more detail about structuring social opportunities to elicit specific social skills.
Structured Communication Opportunities Communication skills can be sampled by structuring natural
communication opportunities and/or creating communication temptations (Wetherby, Watt, Morgan, &
Shumway, 2007). Naturally occurring activities can be organized in a semistructured way to elicit specific
communicative behaviors. Samples of these techniques include the following:
• Place a desired item out of reach and wait for the child to request it.
• Spill something and wait for the child’s response.
• Look through a picture book and wait for the child to comment or ask questions.
• Have a peer give the child a desired object and wait for the child’s response.
• Ask the child to identify an unusual object and observe how the child indicates that he or she does not
know what it is.
• Do something funny, start to laugh, and observe what the child says.
The sample activities and strategies described later in this text provide more detail about using sabotage,
communication temptations, or other forms of naturalistic instruction to elicit specific communication skills.
Direct sampling of skills is a good opportunity to record video examples of the child’s skills. Recordings reveal
the dynamic, reciprocal quality of the child’s interactions and are a permanent record of his or her abilities.

ASCS-2 Assessment Process Case Study: Charlie

This section illustrates the process of assessing social and communication skills in a child with autism using
the ASCS-2. The following case example describes a team assessment of a 6-year-old child named Charlie,
who meets criteria for special education services under the category of autism spectrum disorder. Directions
for completing and scoring the three assessments of the ASCS-2 are provided, as well as instructions on how
to use assessment results for intervention planning. As you read about the assessment process, refer to the
complete ASCS-2 Assessment in the Chapter 3 Appendix.
I. Completing the ASCS-2 Behavior Profile The professionals on Charlie’s team have known him for one
school year and wanted to use the ASCS-2 to obtain a profile of Charlie’s current social and communication
skills and target skills for intervention. The first step was for the team to complete the ASCS-2 Behavior
Profile. Table 3.7 outlines the steps of the process a school team should follow when completing the ASCS-2
Behavior Profile, general guidelines for how these steps can be completed, and a summary of the approaches
that Charlie’s team used to complete this part of the assessment.

Table 3.7. Process to complete the ASCS-2 Behavior Profile

Profile process General guidelines Charlie’s team
Identify team members to complete the assessment Two or more adults familiar with the individual Mother
Special education teacher
Speech-language pathologist
Board Certified Behavior Analyst
(BCBA)
Select evaluator One member of the team is responsible for recording information, scoring data, and writing narrative BCBA
summary
Select method(s) for collecting information and completing Record review Structured team interview
the profile Structured team interview
Observation
Allocate time for the process Approximately 30–60 minutes plus observation time, if needed 45-minute group meeting

Charlie’s team (his mother, special education teacher, speech-language pathologist, and Board Certified

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Behavior Analyst [BCBA]) scheduled a 45-minute meeting during which they worked collaboratively and
conducted a structured team interview, following the directions to complete the ASCS-2 Behavior Profile (see
Box 3.1).

Box 3.1. Directions for completing the ASCS-2 Behavior Profile

How to complete the Behavior Profile:
• Rate level of skill. Circle A = Absent (not present), E = Emerging (sometimes present), or P = Present.
• Provide 3–5 concrete examples of the child’s motivators and skills.
How to complete the ASCS-2 Behavior Profile Summary:
• Briefly summarize the child’s social and communication strengths and areas of need. Include
information collected and recorded by the assessment team.

The team answered each of the questions on the ASCS-2 Behavior Profile, shared information, and
compared and contrasted Charlie’s skills across different adults and settings. When there was disagreement
among team members about Charlie’s abilities, the assigned evaluator made note of differences. Different
viewpoints among the team members reflected a lack of generalized skills. For example, Charlie demonstrates
some social skills in school but not at home; and Charlie demonstrated more communication skills with older
siblings at home, which are not observed in school. The team discovered that Charlie has a large repertoire of
interests and preferences that can be incorporated into his intervention plan, particularly regarding technology
such as tablet and computer games.
Figure 3.1 is an excerpt from Charlie’s ASCS-2 Behavior Profile related to his primary communication
partners. This information was particularly revealing because it shows that Charlie will initiate interactions
with adults, his older siblings, and older family members, but his ability to initiate interactions with same-age
peers is limited. Sometimes, he will independently initiate social interactions and/or communication with
small groups of peers (circled as “emerging” on his assessment profile), but he never initiates interactions in
larger groups (circled “absent”). Charlie’s limited ability to interact with his peers was noted as a particular
area of need in his ASCS-2 Behavior Profile Summary. The team’s narrative summary of Charlie’s strengths,
abilities, and areas of need is presented in Figure 3.2.

Figure 3.1. A portion of Charlie’s ASCS-2 Behavior Profile.

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Figure 3.2. Charlie’s ASCS-2 Behavior Profile Summary.

II. Completing the ASCS-2 Obstacles Questionnaire Charlie has a history of challenging behaviors that
interfere with learning. After completing the ASCS-2 Behavior Profile, the team began to discuss other
behaviors that impede Charlie’s ability to socialize and communicate with others, and the team completed the
ASCS-2 Obstacles Questionnaire. Table 3.8 outlines the steps that a school team can follow to complete the
Obstacles Questionnaire, general guidelines for each of these steps, and a summary of the approaches taken by
Charlie’s team.

Table 3.8. Process to complete the ASCS-2 Obstacles Questionnaire

Obstacles Questionnaire process General guidelines Charlie’s team
Identify team members Two or more adults familiar with the individual Mother
Special education teacher
Speech-language pathologist
Board Certified Behavior Analyst (BCBA)
Select evaluator One member of the team responsible for recording information, scoring, BCBA
summarizing data, and writing narrative summary
Select method(s) Structured team interview Structured team interview
Two to three individual interviews
Observation
Allocate time Approximately 30–60 minutes plus observation time, if needed 20 minutes

Once again, the team used structured interview format to answer the questions, collaboratively generating
responses. They carefully followed the directions to complete the ASCS-2 Obstacles Questionnaire as listed
in Box 3.2.

Box 3.2. Directions for completing the ASCS-2 Obstacles Questionnaire

Rate the degree to which behavior interferes with social and communicative functioning and/or learning.
Circle 0 = No obstacle, 1 = Mild obstacle, 2 = Moderate obstacle, 3 = Significant obstacle.
• Count the total number of 3s (significant obstacles) to gain an overall impression of the obstacle to

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 functioning and learning. Range of scores is from 0 to 6. The higher the score, the more significant the
obstacle.
• Provide one or more concrete examples of the significant obstacles.

The team had a list of Charlie’s challenging behaviors ready, so the questionnaire was completed quickly,
within about 20 minutes. The discussion mostly focused on Charlie’s prompt dependency and restricted and
repetitive behaviors. There was agreement among the team members about Charlie’s most significant
obstacles. Figures 3.3 and 3.4 provide samples of Charlie’s ASCS-2 Obstacles Questionnaire data. Figure 3.3
shows Charlie’s assessment results regarding restricted and repetitive social behaviors, at least three of which
are rated as significant obstacles for him (scores of 3). Examples of Charlie’s repetitive social behaviors
included repeatedly replaying parts of a video, perseverating on specific iPad apps, and becoming agitated or
upset when computer or iPad time is limited. In addition to his perseverative interests and repetitive
behaviors, Charlie has other types of challenging behaviors that are obstacles to social interaction, as shown in
Figure 3.4. Charlie’s team listed four challenging behaviors on this part of the assessment, three of which were
rated as significant obstacles to his social success. Notice that it is important for the team to describe each
obstacle in observable, measurable terms so there is consensus on what the challenging behavior looks like and
what needs to be addressed, observed, and measured through intervention. For instance, instead of simply
noting that Charlie was aggressive, the team specifically defined aggression as hitting, scratching, or kicking
others. After the team identifies specific challenging behaviors on the ASCS-2 Obstacles Questionnaire, it is
recommended that they complete a functional behavioral assessment (FBA) to fully understand the function
of each challenging behavior and the possible relationship between these obstacles and the lack of functional
social and communication skills.

Figure 3.3. Charlie’s ASCS-2 Obstacles Questionnaire: Social Restricted and Repetitive Behaviors.

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Figure 3.4. Charlie’s ASCS-2 Obstacles Questionnaire: Challenging Behaviors.

Through completing the ASCS-2 Obstacles Questionnaire, Charlie’s team was able to identify a large
number of significant obstacles that interfere with Charlie’s social interactions and spontaneous
communication. As shown in Figure 3.5, more than 20 behavioral tendencies were recorded on Charlie’s
ASCS-2 Obstacles Questionnaire Summary. Both a quantitative and a narrative summary of Charlie’s current
challenges are documented on his ASCS-2 Obstacles Questionnaire Summary Form.

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Figure 3.5. Charlie’s ASCS-2 Obstacles Questionnaire Summary.

The team’s next step was to review Charlie’s significant obstacles and prioritize which specific behavioral
obstacles they want to address in his intervention plan in order to maximize his social and communication
development. The ASCS-2 Obstacles Questionnaire Program Planning Form was used for this purpose, and
a short sample of the plan for Charlie is shown in Figure 3.6. The team believed that addressing Charlie’s
negative reaction to restricted access to technology games and his computer should be an intervention priority,
because this was not only a barrier to connecting socially with his peers but also a form of disruptive and
aggressive behavior that required attention. Keep in mind that Figure 3.6 shows only a few examples of
intervention priorities; a completed program planning form could include any number of significant obstacles
targeted for intervention. It is ultimately the responsibility of the team to document priorities according to
what is most important to the child’s well-being and development. Based on the prioritized behavior (i.e.,
Charlie’s disruptive and aggressive reactions to being restricted from his favorite technological devices)
depicted in Figure 3.6, one of the following behavioral objectives was written for Charlie: Through the use of a
visual timer and reinforcement system, Charlie will use his technology device and put it in a specific location without
problem behavior in 75% of the opportunities. For more information on writing measurable objectives as part of
intervention planning, see Chapter 4.

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Figure 3.6. A portion of Charlie’s ASCS-2 Obstacles Questionnaire Program Planning Form.

III. Completing the ASCS-2 Skills Checklist The team had a solid understanding of Charlie’s general
social and communication skills and the number of obstacles that needed to be addressed in his intervention
plan. The next step was to assess what specific skills were in his current repertoire and what skills were lacking
through completing the ASCS-2 Skills Checklist. Table 3.9 outlines the process a school team can follow to
gather information and complete the Skills Checklist, including general guidelines as well as an overview of
the actions taken by Charlie’s team.

Table 3.9. Process to complete the ASCS-2 Skills Checklist

Skills checklist process General guidelines Charlie’s team
Identify team members Two or more adults familiar with the individual Mother
Special education teacher
Speech-language pathologist (SLP)
Board Certified Behavior Analyst (BCBA)
Select evaluator One member of the team responsible for recording information, scoring, BCBA
summarizing data, and writing narrative summary
Select methods Structured team interview Structured team interview
Observation Observation: Scheduled three 30-minute observations over
Direct sampling of skills a 2-week period
Direct sampling of skills: Scheduled two 30-minute sessions
during preferred school activities
Allocate time* Initial: BCBA and SLP met for 1 hour.
*Note: Initial assessment is time-intensive. Approximately BCBA and teacher met for 1 hour.
Follow-up assessment takes significantly less time. 1- to 2-hour interview BCBA and parents met for 1 hour.
1- to 2-hour observation BCBA observed for four 15-minute periods (three in school
1-hour direct sampling and one at home).
BCBA and teacher conducted skill sampling for 30 minutes

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 Follow-up: in school.
Approximately 1-hour total

The team originally believed that Charlie had solid imitation skills and gestural communication and
questioned the need to do the ASCS-2 Core Skills Checklist. However, as the team discussed the specific
skills within each checklist, it became increasingly clear that gaps in Charlie’s core skill development may be
playing a critical role in his limited spontaneous communication and social interactions. The team followed
the directions to complete the ASCS-2 Skills Checklist (see Box 3.3). A number of observations and direct
sampling of skills were required in order to obtain accurate data. Although the initial use of the ASCS-2
Skills Checklist was time intensive, the quality of the intervention plan that was designed as a result of using
the assessment was worthwhile. The team plans to use the ASCS-2 every year to update Charlie’s progress,
measure change, and develop his IEP and intervention plan.

Box 3.3. Directions for completing the ASCS-2 Skills Checklist

1. Rate the level of functional skill use based on the following scoring codes and definitions:
• Absent (A) = Child does not demonstrate the skill.
• Emerging (E) = With or without prompts, child demonstrates the skill in one setting or with only
one person. An emerging skill is one that has been observed some of the time (average 50%) in at
least one setting targeted for instruction.
• Mastered (M) = Without prompts, child demonstrates the skill most of the time in the settings that
have been targeted for instruction. A mastered skill is one that has been observed a majority of the
time (average 80%) in three or more specific settings targeted for instruction.
• Generalized (G) = Child demonstrates the skill in multiple settings and with multiple adults and
peers without prompts. A generalized skill is observed almost 100% of the time in novel settings. It
is a functional applied skill that has been generalized to three or more settings that have not been
targeted for instruction.
It is reasonable to expect that a child will have a combination of absent, emerging, mastered, and
generalized skills within each domain area of the assessment. It also is plausible that a child may
demonstrate a scattering of skills within a domain. Therefore, it is recommended that all items on the
checklists be assessed.
2. Select one skill from each domain area as a priority for intervention. The target skill may be selected
for emergence/acquisition, mastery, or generalization
• Skills scored as A (Absent) are targeted for emergence/acquisition, mastery, or generalization.
• Skills scored as E (Emerging) are targeted for mastery or generalization.
• Skills scored as M (Mastered) are targeted for generalization.
In the Priority column, check off at least one skill from each domain to be targeted for intervention.
3. For each set of items, count the number of absent, emerging, mastered, and generalized skills. Put
each total in the scoring boxes. A high number of generalized skills indicates strengths in this domain.
The numeric scores will be transferred to the ASCS-2 Skills Checklist Summary.

The team was able to complete the Core Skills Checklist and most of the Social Skills Checklist through
the interview process. When completing the Communication Skills Checklist, observations and direct
sampling of skills were used to determine Charlie’s ability to generalize a number of communication skills.
The classroom teacher and Charlie’s mother discussed Charlie’s skills in various community settings to
complete the Community Skills Checklist. Samples of Charlie’s ASCS-2 Skills Checklist data are shown in
Figures 3.7 through 3.10.
Figure 3.7 is a portion of Charlie’s Core Skills Checklist looking at Charlie’s nonverbal interaction skills
within the domain of Nonverbal Gestures. Notice that only three of the eight skills listed were rated as
Generalized (G). The team chose to prioritize the skill “shakes head to say ‘no’” for Charlie, a skill that was
just emerging, with generalization as the desired end goal. This was chosen as a priority because Charlie’s
aggressive behaviors were his way of protesting when he did not want to do something, and the team wanted
to teach him a more functional, safe, and appropriate way to communicate no as a replacement behavior that
he could use in all settings. Figure 3.8 shows a sample from Charlie’s Social Skills Checklist that looks at
Charlie’s play and leisure skills in the domain of Solitary Play and Leisure. Most of the skills in this domain
were scored as either Absent (A) or Emerging (E). The team prioritized the skill of being able to engage in
independent solitary leisure activity for more than 15 minutes as a priority for Charlie, a skill that was absent,

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so that he would be able to persist in play and leisure independently for longer periods of time without
becoming discouraged, disorganized, or frustrated. Figure 3.9 is a sample of Charlie’s Communication Skills
Checklist. This portion of the assessment looks at Charlie’s basic communication skills in the Makes Requests
domain. Most of the skills in this domain area have been scored as Generalized (G), showing that Charlie is
able to spontaneously make a variety of requests across multiple settings and with multiple communication
partners. However, he is unable to request ending an activity or ask for help (scored Absent), two skills that
the team considered intervention priorities. Charlie has difficulty transitioning from one activity to the next,
so teaching him to communicate when he is “all done” was an important skill to decrease his frustration level.
Being able to request help when he became overwhelmed, stuck, or frustrated was of equal importance for his
quality of life and ability to communicate more effectively. These two skills were chosen because Charlie’s
challenging behaviors often occur when he is frustrated, and the team wanted to teach him a more functional,
appropriate way to ask for help and indicate across multiple settings that he wanted to be “done.”

Figure 3.7. Charlie’s Core Skills Checklist: Nonverbal Gestures.

Figure 3.8. Charlie’s Social Skills Checklist: Solitary Play and Leisure.

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Figure 3.9. Charlie’s Communication Skills Checklist: Makes Requests.

Figure 3.10 displays a portion of Charlie’s Community Skills Checklist in the domain of Family Outings.
Charlie’s mother identified four settings in which Charlie lacked skills, and selected two settings (Doctor and
Dentist) as priorities for intervention. Charlie’s family indicated that he participates with family and friends in
many community settings but is very agitated and uncooperative during doctor and dentist visits. The team
will conduct a detailed functional behavior assessment (FBA) in these two specific settings in order to create
an intervention plan for Charlie and his family.

Figure 3.10. Charlie’s Community Skills Checklist: Family Outings.

IV. Summarizing the ASCS-2 Skills Checklist Data After the Core, Social, Communication, and
Community Skills Checklists have been completed, the team transfers data onto the ASCS-2 Skills Checklist
Summary and/or the ASCS-2 Skills Checklist Progress Monitoring Form and Progress Monitoring Display.
The purpose of the scoring is to compare skills across the various domains of social and communication
development. The basic steps to scoring and summarizing the ASCS-2 Skills Checklist data are provided in
Box 3.4.

Box 3.4. Directions for summarizing and interpreting the checklist data
Review the scores on the ASCS-2 Skills Checklist and complete the following forms to summarize the
assessment findings and monitor progress over time:
ASCS-2 Skills Checklist Summary (quantitative summary)
ASCS-2 Skills Checklist Progress Monitoring Display (graphic summary)
ASCS-2 Skills Checklist Progress Monitoring Form (view data over time)
1. ASCS-2 Skills Checklist Summary (quantitative summary)
• Record the number of A (Absent), E (Emerging), M (Mastered), and G (Generalized) skills scored

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 for all domains in each of the four checklists (I. Core, II. Social, III. Communication, and IV.
Community) in the corresponding boxes.
• Add the total number of A (Absent), E (Emerging), M (Mastered), and G (Generalized) skills for
Core, Social, Communication, and Community skills
• Calculate the percentage of skills at each level for Core, Social, Communication, and Community
skills. Divide the number of skills at each level by the total number of skills in that checklist.
2. ASCS-2 Skills Checklist Progress Monitoring Display (graphic summary is optional)
• Transfer all data recorded in the ASCS-2 Skills Checklist onto the Progress Monitoring Display to
obtain a graphic view of skills and to monitor skill development for three consecutive assessments.
• Fill in the specific boxes associated with E (Emerging), M (Mastered), and G (Generalized) skill
levels for all skills in all domain areas. Leave the boxes empty if a skill is absent.
• When using the Display to transfer data for the second or third assessment, fill in the specific boxes
(use a different color) to show which skills and levels have been acquired since the first assessment.
3. ASCS-2 Skills Checklist Progress Monitoring Form: This form duplicates the information on the
ASCS-2 Skills Checklist Summary but displays the data to allow for review of up to three consecutive
assessments:
• Compare the total number of A (Absent), E (Emerging), M (Mastered), and G (Generalized)
skills for the Core, Social, Communication, and Community Checklists.
• Compare the percentage of skills over time for a measure of Core, Social, Communication, and
Community skills progress.

To complete Charlie’s ASCS-2 Skills Checklist Summary, the BCBA transferred the data from all four
checklists onto the summary form and calculated the total number of absent, emerging, mastered, and
generalized skills in each domain area. Figure 3.11 presents data from the Core Skills Checklist, which clearly
displays Charlie’s core skill strengths in imitation (i.e., most skills were generalized) and weaknesses in
nonverbal interaction and self-regulation (i.e., many skills were absent or just emerging). Overall, Charlie has
generalized 38% of the 55 core skills assessed.

Figure 3.11. A portion of Charlie’s ASCS-2 Skills Checklist Summary.

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 The ASCS-2 Skills Checklist Progress Monitoring Display is designed to visually track a child’s
development of skills over time. The Progress Monitoring Display shows all skill domains assessed on the
ASCS-2 Skills Checklist. For each domain, there is a numbered list of discrete skills and a row of three boxes
labeled E (Emerging), M (Mastered), and G (Generalized). After completing the first assessment, shade the
boxes that correspond to the level of each skill:
• Absent skills: Leave boxes empty
• Emerging skills: Fill in the first box labeled E
• Mastered skills: Fill in the boxes labeled E and M
• Generalized skills: Fill in all three boxes, E, M, and G

This shading creates a graphic display of the individual’s skill levels. The ASCS-2 Skills Checklist
Progress Monitoring Display can show progress over time for up to three different assessments. For each new
assessment, use a different color or type of shading, filling in only those specific boxes that show which new
skills and levels have been acquired since the first assessment. Figure 3.12 shows a filled-out portion of the
Progress Monitoring Display for Charlie’s initial assessment using the ASCS-2. This provides the team with
a quick visual reference of Charlie’s current skill levels, and in the future this can be used to track new skills
that have been acquired and monitor progress toward generalized skill use.

Figure 3.12. Charlie’s Progress Monitoring Display for Core Skills: Single Assessment.

One year later, Charlie was reassessed using the ASCS-2. Figure 3.13 shows a section of Charlie’s
Progress Monitoring Display that contains the data from both the initial and second assessment. Boxes
shaded in gray indicate data from the first assessment, whereas the black shading indicates data from the
second assessment. It is clear from this graphic display that Charlie is developing new skills and has mastered
and generalized skills within several core skill domains. For example, between the first and second assessment

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period, Charlie generalized a number of skills in the domains of Nonverbal Gestures and Joint Attention, and
he acquired new skills in the domains of Transitions and Emotional Regulation.

Figure 3.13. Charlie’s Progress Monitoring Display for Core Skills: Multiple Assessments.

V. Program Planning: The Final Step Assessments such as the ASCS-2 are essential in the intervention
planning process, which requires systematic measures of a child’s skill repertoire. When taken together, the
ASCS-2 Behavior Profile, ASCS-2 Obstacles Questionnaire, and ASCS-2 Skills Checklist provide the team
with a comprehensive summary of the student’s current level of functioning and needs. Although the
assessment process and intervention planning should be individualized and determined through a collaborative
team process, there are some general guidelines that the team can follow in determining how to use the
ASCS-2 for program planning:
• Profile: The profile summary provides a narrative snapshot of current strengths and weaknesses. It can
assist in identifying specific motivators that can be used as opportunities for learning (as shown in Figure
3.2).
• Obstacles Questionnaire: The questionnaire identifies specific social, communication, and behavioral
obstacles that need to be reduced or replaced and a planning form to list objectives to decrease behavioral
obstacles (as shown in Figure 3.6).
• Skills Checklists: Keep in mind that the specific domains of the Skills Checklist are not organized as a
hierarchy and are not intended to be addressed in a fixed sequence. Although core skills are essential to
address in all intervention programs, they are not prerequisites for social and communication intervention.
On the contrary, it is expected that program planning will address multiple skills across many of the
domain areas. Priority objectives should be selected from the general core skill areas (i.e., nonverbal social
interaction, imitation, and organization), the general social skill areas (i.e., play and leisure, group skills,
and community social skills), and general communication skill areas (i.e., basic communicative functions,

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 socioemotional skills, and basic conversational skills). The child’s team is encouraged to identify objectives
in most of the skill areas, unless all skills are generalized. Each behavioral objective should specify the
conditions for acquiring emerging skills (E), skill mastery (M), or skill generalization (G). A skill may be
targeted for instruction for multiple reasons; for example, if a skill needs to be taught in multiple contexts,
or generalized to noninstructional settings.

The ultimate goal is for the child with autism to generalize and perform skills independently across
instructional and noninstructional settings, and with a variety of adults and peers. The next chapter delves
more deeply into the intervention planning process.
The ASCS-2 Skills Checklist Program Planning Form is used to summarize priority skills and write
behavioral objectives for intervention. It is the responsibility of the team to prioritize the child’s greatest area
of need, determine the number of goals and objectives to be targeted for instruction at one time, and
determine the order in which social and communication skill priorities are to be addressed over time. Box 3.5
provides the directions to completing the program planning form.

Box 3.5. Directions for completing the ASCS-2 Skills Checklist

Program Planning Form
1. Select specific “priority” skills for intervention from each domain area on the Core, Social,
Communication, and Community Checklists. This should be a team decision based on the child’s
needs. It may not be possible to write an objective for each skill checked as a priority. If there are a
number of skills checked as a priority, the team should target and write goals and objectives based on
the most significant needs of the child.
2. For each priority skill, write an objective in measurable behavioral terms for intervention and indicate
the skill criteria level as Emerging (E), Mastered (M), or Generalized (G).
As emphasized, the process of prioritizing goals and objectives for intervention is a team effort and is
individualized for each child. However, consider these general guidelines:
• Review all the skills marked as “priorities” on the assessment checklists.
• Select priorities for intervention across multiple skill areas: Core, Social, Communication, and
Community.
• Determine the number of skills to be targeted for instruction for the designated time period (e.g., 1
year or more).
• Balance the intervention plan so that there is a distribution of skills targeted for emergence/acquisition
(E), mastery (M), and generalization (G). Some behavioral objectives should target initial skill
emergence/acquisition (E); some objectives are written to build mastery (M) of emerging skills; and
other objectives are written for the child to demonstrate functional generalization (G) of skills.
• If you target only acquisition of new skills, the child may only possess discrete skills demonstrated in
isolated settings. It is therefore important to distribute priorities across all three skill levels (E, M, G).

Let’s return to our case study student, Charlie. With all of the assessment data scored and summarized,
the team leader presented the ASCS-2 summary forms and progress monitoring display to the team at the
IEP meeting. The team used the summary data to complete the ASCS-2 Skills Checklist Program Planning
Form. Charlie’s parents identified the most important priorities for home, and the school team selected some
school-based skills that would be important to develop. This information provided the team with a
comprehensive intervention plan for the upcoming year. Figure 3.14 shows Charlie’s intervention plan as
summarized on the ASCS-2 Skills Checklist Program Planning Form.

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Figure 3.14. Charlie’s ASCS-2 Skills Checklist Program Planning Form.

ASCS-2 Advantages and Limitations

The ASCS-2 is only one instrument for assessing children and youth with autism, and as with all assessment
approaches it has some advantages and limitations that should be acknowledged. The ASCS-2 can be used as
an ongoing intervention planning tool to expand the scope of social and communication goals integrated into
a child or student’s intervention plan. The ASCS-2 offers a number of advantages for those seeking a detailed
profile of a child’s social and communication skills:
• The assessment makes a distinction between a child’s skill acquisition in instructional settings and a child’s
functional and spontaneous use of social and communication skills in the natural environment.
• The assessment is structured so that information can be obtained directly (through observation and direct
sampling) and indirectly (from informants).
• The assessment process involves family members and caregivers via interviews.
• The assessment obtains information on any child, regardless of age, ability level, or presence of challenging
behaviors.
• The assessment is structured to capture the child’s optimal capabilities by gathering information from
multiple informants, activities, and settings.
• The assessment results can be graphed and scored to monitor skill emergence/acquisition (E), skill mastery
(M), and skill generalization (G) over time.
• The assessment results link directly to instructional goals and objectives.
• The assessment examines a wide range of specific social and communication skills, the most critical aspects
of development in children and youth with autism.

Of course, although there are many advantages to the ASCS-2 instrument, it is not without limitations:

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• First, there are recognized drawbacks to this and other informal measures that lack standardization. The
ASCS-2 can supplement standardized tools during the assessment process; however, this instrument
cannot be used to document service needs if the state or school district requires standardized assessments
for this purpose.
• Second, the assessment does not incorporate normative data. It is structured to identify discrete skills that
are challenges associated with autism and is not organized in a developmental hierarchy. For example, in
the core skills domain of Nonverbal Social Interaction, all of the listed skills emerge simultaneously in
typically developing infants, but one or more can be lacking in children with autism at various levels of
cognitive ability. Similarly, many of the communication domains emerge simultaneously in typically
developing children, but one or more may be absent in individuals with autism of any age. The authors of
this assessment tool determined, however, that the application of a typical developmental hierarchy of skills
would not capture the complexity of social and communication issues in autism, many of which require
direct instruction.
• Third, the profile of a child’s skills obtained via this tool depends on the reliability of the informants.
Inaccuracy is always a concern when information is gathered indirectly through methodology such as
interviews. Informants can misinterpret the child’s skills, underestimate the child’s abilities, or assume that
he or she possesses greater skills than those actually demonstrated. Nevertheless, this matter can be easily
controlled because the measure advocates the use of multiple informants and the verification of
information through the direct measures of observations and direct sampling.
• Finally, the assessment is limited by the observation skills of the person conducting the evaluation.
Observation skills are highly dependent on the examiner’s understanding of the skills to be observed. For
this reason, this book offers many strategies for augmenting observation skills and provides vignettes about
each of the social and communication skills addressed.

SUMMARY
A careful and thorough assessment process is critical for identifying students’ strengths and areas of need, for
developing goals and objectives and a quality intervention plan, and for monitoring progress over time. A
variety of assessment tools are available to assess children with autism, each with their advantages and
limitations. These include formal, standardized instruments, which describe an individual’s performance
relative to a normative sample, and informal, criterion-referenced tools that provide qualitative results that can
be directly linked to intervention. Available assessments include diagnostic and screening tools, adaptive
behavior scales, social assessments, communication assessments, pragmatic assessments, and curriculum based
assessments. This chapter has particularly emphasized the use of the revised ASCS-2 as an effective tool for
measuring social and communicative competence and developing an intervention plan. This instrument not
only develops a profile of the social and communication skills in the child’s repertoire but also measures and
tracks the level of skill acquisition, with the goal of having the student generalize important skills over time.
The ASCS-2 examines numerous discrete skills in the domains of social and communication functioning.
Unfortunately, there is no easy way to assess social and communicative competence except by artificially
separating it into various components. It is imperative to recognize, however, that social and communication
development is not merely a sum of individual social and communication skills but a dynamic progression that
takes place in context and so is a qualitatively different experience for every child. The ASCS-2 is intended to
guide one’s understanding of the child with autism, to foster discussion about the core issues challenging
children with autism, and to promote program planning that takes into account the most critical elements of
intervention.

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ASCS-2 Behavior Profile
CHAPTER 3 APPENDIX

Overview
Purpose
The purpose of the ASCS-2 Behavior Profile is twofold:
• It develops a general profile of a child’s current social and communication abilities, including strengths as
well as challenges.
• It identifies motivators that can affect learning, including preferred social and communication partners,
activities, interests, reinforcement, and emotional regulation strategies.

Format
The ASCS-2 Behavior Profile consists of six areas:
Section 1. Social and Communication Partners
Section 2. Social Activities
Section 3. Social Interactions
Section 4. Communication Foundation
Section 5. Communication Means
Section 6. Communication Functions

Administration
It is recommended that the ASCS-2 Behavior Profile be administered before completing the ASCS-2 Skills
Checklist. The profile can be repeated annually as part of the child’s individualized education program annual
review.
The profile is completed by:
Structured team interviews: The profile is designed as a structured interview. It is completed by an evaluator
who knows the child with autism and by two or more reliable informants such as parents, teachers, and
therapists.
• It is recommended that team members work collaboratively to answer the questions, share information,
and compare and contrast the child’s general skills in different settings and social contexts.
• If there is disagreement among team members about the child’s abilities, the evaluator makes note of the
differences. Different viewpoints among team members may reflect a lack of generalized skills in the child
with autism (e.g., the child may demonstrate social and communication skills in one setting or with one
adult more frequently and has not generalized skills across all settings and with all adults and peers).
• If there is uncertainty among team members about the presence of a specific skill, the evaluator can gather
additional information through a review of records and/or direct observation(s).
Record review: Information can be gathered through a review of documents.
Observations: Information can be gathered through observations. The evaluator can watch the child with
autism during multiple activities during which opportunities to demonstrate a skill will naturally occur. It is
recommended that multiple observations occur over the course of a number of days in a number of settings.

Directions
• Rate level of skill. Circle A = Absent (not present), E = Emerging (sometimes present), or P = Present.

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• Provide 3–5 concrete examples of the child’s motivators and skills.

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ASCS-2 Obstacles Questionnaire
CHAPTER 3 APPENDIX

Overview
Purpose
The purpose of the ASCS-2 Obstacles Questionnaire is to gather essential information about the child’s
restricted and repetitive tendencies and other challenging behaviors that can interfere with learning and serve
as obstacles to socialization and communication.

Format
The ASCS-2 Obstacles Questionnaire examines six obstacles to functioning and learning:
Section 1. Social Behaviors
Section 2. Communication Behaviors
Section 3. Prompt Dependency
Section 4. Sensory Challenges
Section 5. Social Motivation
Section 6. Challenging Behaviors

Administration
It is recommended that the ASCS-2 Obstacles Questionnaire be completed along with the ASCS-2 Behavior
Profile and updated annually as part of the child’s individualized education program annual review. The
questionnaire is completed by an evaluator who is familiar with the child with autism and two or more reliable
informants, ideally a parent and a teacher or therapist. The questionnaire can be completed through structured
interview or independently if the team member is familiar with the ASCS-2.
Structured team interviews: The questionnaire may be completed through structured interviews. The
evaluator will have each team member complete the questionnaire separately. The evaluator can distribute and
collect the questionnaires from different team members and then compile the information in the summary
form. If there is disagreement among team members about the child’s abilities, make note of differences.
Different viewpoints among the team members may reflect different behaviors displayed by the child with
autism across various settings (e.g., child may demonstrate different behavioral challenges and obstacles in one
setting or with one adult more frequently).
Observations: Any uncertainty about the child’s challenges or the accuracy of the material obtained through
interviews can be confirmed through direct observations. For maximum effectiveness, multiple observations
should occur over a number of days, in multiple settings, and during various activities.

Directions
• Rate the degree to which behavior interferes with social and communicative functioning and/or learning.
Circle 0 = No obstacle, 1 = Mild obstacle, 2 = Moderate obstacle, 3 = Significant obstacle.
• Count the total number of 3s (significant obstacles) to gain an overall impression of the obstacle to
functioning and learning. Range of scores is from 0 to 6. The higher the score, the more significant the
obstacle.
• Provide one or more concrete examples of the significant obstacles.

DO-WATCH-LISTEN-SAY: Social and Communication Intervention for Autism Spectrum Disorder, Second Edition, by Kathleen Ann Quill and L.
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ASCS-2 Skills Checklist
CHAPTER 3 APPENDIX

Overview
Purpose
The purpose of the ASCS-2 Skills Checklist is to determine whether specific skills are in the child’s
repertoire, and whether each skill is (A) Absent, (E) Emerging, (M) Mastered, or (G) Generalized. The most
common use of the checklist is for educational planning.

Format
The ASCS-2 Skills Checklist contains measures of social and communication competence in four areas:
Part I. Core Skills Checklist
Part II. Social Skills Checklist
Part III. Communication Skills Checklist
Part IV. Community Skills Checklist (requires integration of core, social, and communication skills).

Administration
The checklist can be completed yearly as part of the individualized education program annual review process.
It may be completed through structured team interviews, observations, and/or direct sampling.
Structured team interviews: May be used if the evaluator knows the child with autism and he/she has two or
more reliable informants such as parents, teachers, and therapists. It is recommended that team members
work collaboratively to answer the questions, share information, and compare and contrast the child’s general
skills in different settings and social contexts.
• If there is disagreement among team members about the child’s abilities, the evaluator makes note of the
differences. Different viewpoints among the team members may reflect a lack of generalized skills (e.g., the
child may demonstrate social and communication skills in one setting or with one adult more frequently
and has not generalized skills across all settings and with all adults and peers).
• If there is uncertainty among team members about the presence of a specific skill, the evaluator should
assess the child’s skill level through direct observation(s) and/or direct sampling.
Observations: Requires the evaluator to watch the child with autism during multiple activities in which
opportunities to demonstrate a skill will naturally occur. It is recommended that multiple observations occur
over the course of a number of days and in a number of settings.
Direct sampling: Requires the evaluator to set up at least three different activities or situations to elicit a
specific skill and record the child’s ability to demonstrate the skill. It is recommended that direct sampling
occur in three situations (two familiar and one novel).

Directions
1. Rate the level of functional skill use based on the following scoring codes and definitions:
• Absent (A) = Child does not demonstrate the skill.
• Emerging (E) = With or without prompts, child demonstrates the skill in one setting or with only one
person. An emerging skill is one that has been observed some of the time (average 50%) in at least one
setting targeted for instruction.
• Mastered (M) = Without prompts, child demonstrates the skill most of the time in the settings that
have been targeted for instruction. A mastered skill is one that has been observed a majority of the time
(average 80%) in three or more specific settings targeted for instruction.

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 • Generalized (G) = Child demonstrates the skill in multiple settings and with multiple adults and peers
without prompts. A generalized skill is observed almost 100% of the time in novel settings. It is a
functional applied skill that has been generalized to three or more settings that have not been targeted
for instruction.
It is reasonable to expect that a child will have a combination of absent, emerging, mastered, and
generalized skills within each domain area of the assessment. It also is plausible that a child may
demonstrate a scattering of skills within a domain. Therefore, it is recommended that all items on the
checklists be assessed.
2. Select one skill from each domain area as a priority for intervention.
The target skill may be selected for emergence/acquisition, mastery, or generalization.
• Skills scored as A (absent) are targeted for emergence/acquisition or mastery.
• Skills scored as E (emerging) are targeted for mastery or generalization.
• Skills scored as M (mastered) are targeted for generalization.
In the Priority column, check off at least one skill from each domain to be targeted for intervention.
3. For each set of items, count the number of absent, emerging, mastered, and generalized skills. Put each
total in the scoring boxes. A high number of generalized skills indicates strengths in this domain. The
numeric scores will be transferred to the ASCS-2 Skills Checklist Summary.

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ASCS-2 Skills Checklist
CHAPTER 3 APPENDIX

Summary and Planning Forms

Directions
Review the scores on the ASCS-2 Skills Checklist and complete the following forms to summarize the
assessment findings, plan goals and objectives, and monitor progress over time:

ASCS-2 Skills Checklist Summary, pp. 130–131 (quantitative summary)

• Record the number of (A) Absent, (E) Emerging, (M) Mastered, and (G) Generalized skills scored for all
domains in each of the four checklists (I. Core, II. Social, III. Communication, and IV. Community) in
the corresponding boxes.
• Add the total number of (A) Absent, (E) Emerging, (M) Mastered, and (G) Generalized skills for Core,
Social, Communication, and Community skills.
• Calculate the percentage of skills at each level for Core, Social, Communication, and Community skills.
Divide the number of skills at each level by the total number of skills in that checklist.

ASCS-2 Skills Checklist Progress Monitoring Display, pp. 132–134 (graphic

summary)
• Transfer all data recorded in the ASCS-2 Skills Checklist onto the Progress Monitoring Display to obtain
a graphic view of skills and to monitor skill development for three consecutive assessments.
• Fill in the specific boxes associated with (E) Emerging, (M) Mastered, and (G) Generalized skill levels for
all skills in all domain areas. Leave the boxes empty if a skill is absent.
• When using the Display to transfer data for the second or third assessment, fill in the specific boxes (use a
different color) to show which skills and levels have been acquired since the first assessment.

ASCS-2 Skills Checklist Progress Monitoring Form, pp. 135–136 (optional)

This form duplicates the information on the ASCS-2 Skills Checklist Summary but displays the data to allow
for review of up to three consecutive assessments.
• Compare the total number of (A) Absent, (E) Emerging, (M) Mastered, and (G) Generalized skills for
the Core, Social, Communication, and Community checklists.
• Compare the percentage of skills over time for a measure of Core, Social, Communication, and
Community skills progress.

ASCS-2 Skills Checklist Program Planning Form, pp. 137–139

• Select priorities for intervention across multiple skill areas: Core, Social, Communication, and
Community.
• Balance the selection of priorities to include skills targeted for initial (E) Emergence/Acquisition, (M)
Mastery, and for functional (G) Generalization. If you target only acquisition of new skills, a child may
possess only discrete skills demonstrated in isolated settings. Distribute priorities across skill levels.
• Once priority skills are identified, write objectives in measurable behavioral terms for intervention.

See the form for additional instructions.

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 CHAPTER 4

Designing Intervention

LEARNING GOALS:
1. Design intervention plans using a systematic framework to assess, target, and teach social and
communication skills and address restricted and repetitive patterns of behavior that interfere with learning
and development.
• Conduct assessment to identify present levels of performance and prioritize needs.
• Target goals, based on prioritized needs, to develop social and communication skills.
• Use the DO-WATCH-LISTEN-SAY framework to design intervention.
• Use the DO-WATCH-LISTEN-SAY framework to teach targeted skills in the intervention plan,
working toward acquisition, mastery, and generalization of functional skills.
• Create predictable and motivating opportunities for social and communication skill development.
• Learn how to assess and uncover underlying reasons for restricted and repetitive behaviors.

S ocial and communication skills encompass virtually every aspect of daily life; thus, efforts to build these
functional skills in children with autism can be an overwhelming task for educators and parents. Social
and communication intervention is further complicated by the restricted and repetitive behaviors
characteristic of autism. The purpose of this chapter is to provide frameworks for designing social
communication intervention. There are multiple steps involved with intervention planning (see Figure 4.1),
which are as follows:

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Figure 4.1. Intervention planning.

1. Assess to identify present level of skills and needs.

2. Target goals based on prioritized needs that reflect critical milestones in typical development. Use
assessment summary data to translate general goals into specific, measurable objectives.
3. Plan an intervention to meet goals and objectives and use a framework (e.g., DO-WATCH-LISTEN-
SAY) to guide intervention planning.
4. Teach targeted skills in the intervention plan, working toward acquisition, mastery, and generalization of
functional skills, by using evidence-based practices (EBPs). Use the EBPs presented in Chapter 5, the
instructional strategies and supports found in Chapters 6 and 7, and the sample activities in Chapter 8 to
teach these skills.
5. Monitor progress on the emergence/acquisition, mastery, and generalization of functional skills using data
collection methods. Refer to Chapter 9 for guidance on using data sheets to monitor progress.

INTERVENTION PLANNING: AN OVERVIEW

Building functional social and communication skills is important when planning intervention for children
with autism. Another critical component of intervention planning is to address any restricted and repetitive
behaviors that interfere with learning and functioning. It is important to recognize that these behaviors may
serve social and/or communication purposes and that intervention to build social and communication skills
can indirectly affect behaviors that interfere with an individual’s quality of life. As social and communication
skills are acquired and social competence increases, there can be a decrease in restricted, repetitive, and other
challenging behaviors. The ultimate goal is to design intervention plans that develop critical social and
communication skills and help children achieve functional independence.
The central components of systematic program planning (see Figure 4.2) include the use of assessment
data to establish present levels of performance and prioritize needs, the selection of target goals and specific
objectives, the use of EBPs within the context of meaningful activities, and the collection of data to monitor
progress. Table 4.1 further explains the components of intervention planning and provides sample questions
to guide team decisions.

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Figure 4.2. Systematic steps for program planning.

Table 4.1. Basic components of intervention planning

Component Explanation Questions to ask
Assess present levels of performance Use assessment data to establish present levels of performance that serve as What skills can the child do now?
baseline information and the starting point from which to determine progress What are the child’s strengths?
toward goals. What are the child’s needs related to the disability?
Present levels of performance are skills a child is able to do now. A present-level What are the parents’ concerns?
statement in an individualized education program includes components such How does the disability affect progress in age-appropriate
as strengths, needs, parental concerns, and how the disability affects progress activities?
in age-appropriate activities.
Prioritize needs Use the present levels of performance to prioritize needs, identify obstacles, and What are the most critical areas of need?
determine what skills need to be taught. What obstacles impact independence and quality of life?
What is the vision for the child’s future?
Target general goals Use the prioritized needs to establish clear long-range goals. What will the child do? (Increase skills based on prioritized
Goals are based on what a child can reasonably be expected to accomplish in a needs)
period of time (e.g., 12 months) and should be observable and measurable. To what degree will the child demonstrate skills at the end?
(Functional criteria).
Target specific objectives Use the goals to establish specific short-term objectives. What will the child do? (Steps toward goal)
Objectives are benchmarks that define the discrete steps to a goal. Under what conditions?
Objectives are the general indicators of progress toward a goal. To what degree will the child demonstrate skill at the end?
Create a minimum of two objectives for each goal. (Functional criteria: mastery or generalization).
How will progress be evaluated?
Measure progress Use the specific objectives to establish how progress will be measured. What criteria will be used to determine when the child has
Agree on criteria for evaluating functional skill use. met the specific objective?
Measure acquisition, mastery, and generalization of targeted skills. How will achievement of specific objectives be measured?
Measure progress at regular time intervals. How often will specific objectives be measured?

Establish Present Levels of Performance and Prioritize Needs

Assessments should be used to determine present levels of performance and prioritize needs. When using the
ASCS-2, it is important to remember that the listed skills should not be viewed as a fixed developmental
hierarchy. Rather, the assessment information should be used in a flexible way to guide intervention decisions.
The assessment summary and program planning forms can help guide the team to prioritize goal areas and
target specific skills for intervention based on the child’s present levels of functioning. A team will meet and
review the assessment data, and the family will collaborate and be involved in all decision making. During
collaborative meetings, the team will prioritize the child’s greatest area of need, determine the number of goals
and objectives to target for instruction during the time period of the plan, and determine the order in which
social and communication skill priorities are to be addressed over time.
Intervention decisions about the scope of the social and communication plan should come from careful
team deliberation and consensus and will be based on the unique profile of the child or young person with
autism. Consideration should be given to what the child can do now and what that individual, his or her
family, and educational team want the child to be able to do in the future. Person-centered planning processes
such as Making Action Plans (MAPS; Forest & Lusthaus, 1990), and Choosing Outcomes and
Accommodations for Children (COACH; Giangreco, Cloninger, & Iverson, 2011) can help identify valued
life outcomes for a child with autism (e.g., communication, peer relationships). The intervention plan includes
both 1) goals that address the key features of autism, including challenges with socialization and
communication; and 2) goals that address the social obstacles and behaviors associated with the restricted,
repetitive, or stereotyped patterns of behavior in autism. The wide range of possible social and communication
skills necessary for participating in home, school, and community environments makes it necessary to select
functional skills based on the most critical and timely needs. Asking some basic questions, based on the

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recommendations of the National Research Council (2001), can help the team make decisions when
prioritizing critical skills for intervention:
• Is the skill important to meet the individual’s and family’s prioritized desires and valued life outcomes?
• Is the skill important to increase quality of life, independence, and self-esteem?
• Is the skill critical to ensure health and safety (e.g., communication skills related to personal care, health,
illness, or accidents)?
• Is the skill necessary to participate in home, school, and community social activities (e.g., imitation, social
initiations, social responses)?
• Is the skill necessary to communicate effectively and efficiently (e.g., nonverbal communication skills,
speech, a functional AAC system)?
• Is the skill necessary to interact and maintain emotionally significant social relationships (e.g., engagement
and flexibility in developmentally appropriate play and leisure activities)?
• Is the skill necessary to enhance organization and learning (e.g., asking for help, completing a task
independently, following instructions in a group, managing play and leisure time)?
• Is the skill important to prevent challenging behaviors (e.g., skills related to prevention of self-injurious
behaviors, such as a more functional means of communication)?
• Is the skill developmentally age-appropriate?

If the child has multiple areas of need, hard decisions will need to be made. The team does not want to
generate so many goals and objectives for a plan that they cannot dedicate the time and effort needed for the
child to acquire, master, and generalize the skills. Priority should be given to critical skill areas that have
implications throughout the lifespan of the individual. When professionals and families have to choose
between skills such as “expressing when hurt” or “initiating a social interaction with a peer,” a safety concern
would take precedence over a social skill. Ultimately, professionals and families want to ensure that each plan
leads directly to positive, meaningful outcomes. The following vignette illustrates planning intervention based
on family priorities.

Ben has a few solitary interests and uses single words to make basic requests. Ben’s team used the ASCS-2 to assess
social and communication skills and asked his parents about their priorities for Ben. They identified two goal areas: 1)
leisure activities with peers and 2) prosocial communication skills. After a discussion about the families’ social interests,
and those of his school peer group, the team identified specific objectives that included the following: 1) increase Ben’s
level of independence in three structured group activities that require parallel participation (e.g., hiking, biking, golf)
and 2) acquire and generalize use of four prosocial statements (e.g., “please,” “thank you,” “love you,” and “it’s good”).
These were skills valued by his extended family, and Ben could use these skills across his lifespan in a variety of social
settings.

Target Goals and Objectives with a Means to Measure Progress

After establishing priority skills that need to be taught, the next step in designing an intervention plan is to
identify clear and specific measurable goals and objectives. The following are helpful guidelines to follow in
writing meaningful goals and objectives in an intervention plan:
• Goals are based on what a child or student can reasonably be expected to accomplish in a period of time
such as a school year. Criteria for meeting that goal should be included, such as the extent to which the
child is expected to demonstrate the skill at the end of the specified time period. Goals should be written
in measurable and action-oriented terms and be attainable, realistic, and time bound.
• Objectives are benchmarks that define the discrete steps to a goal. A minimum of two objectives should be
written for each goal. The specific objectives comprising the intervention plan can be selected from the
areas of social and communication development addressed within assessments. In addition to naming the
target skill to be acquired, mastered, or generalized, objectives generally specify conditions, evaluation
criteria, and means for determining the student’s progress toward the goal. Table 4.2 describes the three
components that should make up objectives and notes examples.

Table 4.2. Writing specific objectives

In addition to the target skill, objectives should include the following components: 1) conditions, 2) evaluation criteria, and 3) measurement systems.
Component Description Examples

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1. Conditions The circumstances under which the target skill is demonstrated During five specific activities and using a visual support, the learner will
_______.
Given a conversation starter in a novel setting, the learner will _______.
During school recess, the learner will _______.
With peer support, the learner will _______.
With the use of a gestural prompt, the learner will _______.
After a peer initiates a greeting, the learner will _______.
Independently in the community, the learner will _______.
2. Evaluation criteria A quantitative measure of how often the target skill will occur once the objective In ___% of opportunities presented
is met (i.e., to what level or degree) With ___% accuracy
In ___ of ___ times a day or per class period
In ___ of ___ observations
For ___ minutes
For more than ___ times in an hour
3. Measurement systems How demonstration of the target skill will be measured (e.g., as measured by) Observations by teacher/support staff
Data collection sheets
Language samples
Permanent products

Box 4.1 presents examples of target goals and their corresponding objectives. Note that these examples
include only the target skills and not the conditions, evaluation criteria, and measurement systems.

Box 4.1. Examples of social and communication goals and objectives

Core Skills
Goal: Increase nonverbal social–communicative interaction
Objective 1:_______ will respond to a person, saying his or her name, by stopping and looking
Objective 2:_______ will look at object pointed to by another person
Objective 3:_______ will give object to share interest with another person
Objective 4:_______ will shake head to indicate no
Objective 5:_______ will use conventional gestures to maintain interaction
Goal: Increase imitation skills
Objective 1:_______ will imitate single words during a familiar activity
Objective 2:_______ will imitate single actions with an object on request
Objective 3:_______ will imitate spontaneously the actions of others during a novel activity
Objective 4:_______ will imitate word(s) on request in a novel context
Objective 5:_______ will imitate spontaneously the words of others during an activity
Goal: Increase organization skills
Objective 1:_______ will keep objects/materials in designated areas during an activity
Objective 2:_______ will transition to the next activity when directed
Objective 3:_______ will transition when an unexpected change occurs
Objective 4:_______ will make a preference choice between two objects during an activity
Objective 5:_______ will attend to familiar activity until completed
Social Skills
Goal: Increase solitary play and leisure skills
Objective 1:_______ will engage with one object using materials functionally
Objective 2:_______ will engage in routine predictable scripts
Objective 3:_______ will engage in open-ended activities with no distinct beginning or end
Objective 4:_______ will engage in symbolic-pretend, creative, or novel use of materials
Objective 5:_______ will engage in independent solitary play or leisure activity for more than 15 minutes
Goal: Increase social play and leisure skills
Objective 1:_______ will share objects and materials with a partner
Objective 2:_______ will take turns in small, structured non–language-based group activity
Objective 3:_______ will cooperate with a peer during an unstructured open-ended play or leisure activity
without a common goal
Objective 4:_______ will engage in a parallel non–language-based group activity with organized
objects/materials
Objective 5:_______ will cooperate in unstructured open-ended group play or leisure activity with a
shared common goal
Goal: Increase group skills
Objective 1:_______ will sit for structured group activity
Objective 2:_______ will participate in structured hands-on projects that require no sharing, turn taking,
or verbal interaction

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 Objective 3:_______ will transition with a group
Objective 4:_______ will follow routine verbal group directions
Objective 5:_______ will takes turns during unstructured group activity
Goal: Increase social perspective-taking skills
Objective 1:_______ will allow one or more peers to join in an activity
Objective 2:_______ will imitate common emotions
Objective 3:_______ will identify common emotions in a familiar person
Objective 4:_______ will help others when asked
Objective 5:_______ will incorporate peers’ ideas into activities
Communication Skills
Goal: Increase basic communication skills
Objective 1:_______ will request more
Objective 2:_______ will respond to “What do you want?”
Objective 3:_______ will respond to others’ simple routine comments
Objective 4:_______ will describe location
Objective 5:_______ will ask for information about cause (e.g., “Why?”)
Goal: Increase socioemotional skills
Objective 1:_______ will request a break when upset
Objective 2:_______ will express when hurt, sick, or tired
Objective 3:_______ will use assertive language
Objective 4:_______ will offer an apology
Objective 5:_______ will compliment others
Goal: Increase conversation skills
Objective 1:_______ will initiate a conversation by gaining a person’s attention
Objective 2:_______ will initiate conversations with routine scripts
Objective 3:_______ will maintain natural proximity (i.e., personal space) to speaker
Objective 4:_______ will participate in conversations on topics outside of interest areas
Objective 5:_______ will modulate volume of voice for the setting
Community Skills
Goal: Increase community skills
Objective 1:_______ will demonstrate age-appropriate skills while riding in the car
Objective 2:_______ will demonstrate age-appropriate skills during group outings
Objective 3:_______ will demonstrate age-appropriate skills at birthday parties
Objective 4:_______ will demonstrate age-appropriate skills during holiday celebrations
Objective 5:_______ will demonstrate skills necessary to get a haircut

FRAMEWORK FOR TARGETING SKILLS

An abundance of different skills must be considered when developing an individual intervention plan. The
quantity and variety of social and communication skills embedded in assessment instruments can be
overwhelming for families and interventionists. When selecting goals and objectives from social and
communication areas, there are four factors (see Figure 4.3) that can help establish meaningful skill priorities:

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Figure 4.3. Framework for targeting meaningful skills.

• Maximize the child’s social and communicative competence

• Mirror the social and communication skills of same-age peers
• Increase spontaneity
• Build generalization

Maximize Social and Communicative Competence

Target goals and objectives that are developmentally appropriate, age appropriate, and functional. Select social
and communication skills that will be used in multiple contexts and for many years (i.e., ageless). In the area
of socialization, it is preferable for a child to develop a wide range of play and leisure interests that can either
serve as solitary activities or be shared with same-age peers. Activities such as riding a bike, doing art projects,
and using a computer will remain useful throughout an individual’s life. Consideration must be given to the
appropriateness of selecting developmental play activities that require creativity and imagination. These skills
are difficult for some children with autism and, after the preschool years, lose their utility in social peer
groups.
In the area of communication, it is more efficient for a child to develop a wide range of single words that
serve many communicative functions than to develop multiple means of communicating for a single purpose.
For example, instead of the child building his or her request repertoire by expanding sentence length, from
“(cookie)” to “want (cookie)” to “I want (cookie)” to “I want (cookie), please,” it is more helpful for the child
to use one conventional gesture, sign, symbol, or word that is relevant and serves many different functions.
For example, teaching the child to use a pointing gesture or use the single word “want” or “more” can get his
or her needs met in a variety of different social contexts. Targeting a broader range of single words for many
communicative functions will increase social–communicative competence and can decrease the usual precursor
to challenging behaviors—frustration. A careful review of the child’s social and communication profile is
necessary to target goals and objectives that are both developmentally and functionally useful.

Mirror Social and Communication Skills of Same-Age Peers

Target goals and objectives that have the child acquiring skills that mirror those of same-age peers, taking into
account peers’ behaviors and interests. Identify social and communication skills that are most important by
observing how the activity or situation naturally occurs for typically developing same-age peers. In the area of
socialization, teach the child with autism play and leisure activities and interests common to other peers in his
or her age group to foster social acceptance. Social acceptability often is linked to similar interests. In
preschool, popular toys related to movie characters often signal acceptability. In elementary school, interests
such as sports, video games, and computers often signal acceptability.
In the area of communication, consider how same-age peers communicate. Among typical preschoolers,
nonverbal interaction is primary and conversational exchanges among peers are secondary. In elementary
school, there is a gradual shift to peer-to-peer conversations. The communication messages taught to children
with autism should mirror the social–communicative behaviors used by typically developing children. For
example, typically developing young children do not communicate by saying, “Hello, how are you today?” or
“Do you want to play?” but rather, “Hey” or “Look at this” or they might give a high five. Learning socially
appropriate skills is a continuous process whereby an individual learns societal values, cultural norms, and
skills appropriate to role (e.g., how to interact with teacher versus student, adult versus child, friend versus

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stranger), age, gender, and setting. Norms change as a child matures. In addition, examine the common
questions and comments expressed by others in a setting to target specific messages. For instance, during meal
time, there are opportunities to request or refuse items, to request assistance, to comment when giving items
to others, to use prosocial statements, and to indicate when finished. While doing an art project, a student
might request and label materials, comment on his or her actions, call attention to his or her work, or
compliment others. Target the specific communicative functions (e.g., request an object from a peer,
compliment others) to be included within the activity or routine, along with the means (e.g., word, phrase,
communicative behavior) of expression.

Increase Spontaneity
Target goals and objectives to increase spontaneity by examining the degree to which the child requires
prompts. Social and communication skills are not mastered until a child uses them spontaneously, and skills
are not generalized until they can be used in novel situations. It is significantly more useful to be able to
spontaneously request a desired item than to wait to be prompted with the question “What do you want?” to
get a need met. Similarly, there is a sizeable distinction between being able to answer the question “What is
it?” and being able to spontaneously label things of interest. The child who can spontaneously request or label
an item without prompting is more independent. The role of the child as a responder versus the role of the
child as an initiator must be clear when designing target goals and objectives in many skill areas.

Build Generalization
Target goals and objectives that specifically address functional use and generalization of existing skills.
Children with autism frequently demonstrate specific social or communication skills in certain contexts but do
not generalize the skills across multiple settings. Many times, a child with autism only demonstrates a specific
social or communication skill precisely as it was learned in the presence of a specific stimulus (e.g., person,
prompt, direction), and the skill is not demonstrated in novel situations. If a skill is demonstrated only in
specific contexts, the intervention objective is to generalize the skill across multiple environments.
The following examples illustrate the lack of generalization in children with autism:
Gonzalez will take turns with an adult but not with a peer.
Abigail requests items from adults but does not make the same requests to peers.
Margaret responds to a greeting only when her mother is there to prompt her.
Roger asks for help only from one specific teacher who prompts him in one way.
Jason only engages in functional solitary play and leisure with two activities.
Bradley communicates his need for help at mealtimes but not during other activities.
Target objectives to build generalization when a skill is demonstrated only in certain contexts, such as only
in one environment or only with a specific partner. If a social or communication skill is demonstrated only
with adults, the objective should focus on generalization of the skill to interactions with peers. (It is important
to note that some skills from the ASCS-2 assessment tool, such as organizational skills or solitary play and
leisure, are performed independently of partners.)
Determining whether a skill has been sufficiently generalized can be difficult without a comprehensive
assessment through team observations and discussion. Unlike the ASCS-2, many assessments only identify
the presence or absence of a skill and do not denote whether an acquired skill is mastered or generalized. The
ASCS-2 is unique in that it distinguishes between skills mastered through instruction and functional,
generalized skills that are present in novel and independent ways.
An intervention plan that focuses only on the acquisition of skills may result in an individual who may
possess a large number of discrete skills but may not have skills that are functional and can be used in multiple
settings. As outlined in Figure 4.4, there are three levels of skill acquisition: emerging, mastered, and
generalized.

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Figure 4.4. Levels of skill acquisition.

• An emerging skill is a skill demonstrated under only one condition (e.g., one setting, one person, one
stimuli). In order for a child with autism to become proficient with the skill, it must be taught in multiple
contexts, either sequentially or simultaneously. Provide direct instruction to assist the individual in the
acquisition of each new social and communication skill.
• A mastered skill is a skill demonstrated across multiple instructional conditions, generally a minimum of
three to five different settings, people, and activities. Mastery may be measured by the child’s ability to
maintain responses in targeted situations over time.
• A generalized skill is a skill demonstrated across multiple settings, natural environments, multiple people,
and both familiar and novel stimuli conditions over time. A generalized skill is used functionally and
independently across a range of natural contexts that have not been directly targeted for instruction.
Often, in both the behavioral and developmental fields, there is an arbitrary distinction between mastery
and generalization. It is important to make a clear distinction between mastery and generalization for
planning and monitoring “true” functional skill acquisition. Generalization of social and communication skills
often does not occur automatically in children with autism.
The absence of joint attention, the foundation for ToM, may be one core skill deficit that results in an
inability to generalize (Quill, 2005). The basic skill of shared joint attention allows children to watch others
and learn naturally how to use skills in multiple contexts from those around them. Not sharing experiences
with others means that the child is missing socially relevant information that contributes to generalization. As
a result, intervention needs to directly address the steps toward skill generalization. From a behavioral
perspective, this inability to generalize can be the result of narrow instructional conditions. For example, if
always taught greetings while sitting in a classroom and responding to a teacher’s prompt, a student may not
generalize this skill beyond the one setting. In order for generalization to occur, the skill must become
naturally reinforcing and contextually meaningful. For example, teach the child to respond to a greeting with a
peer in many different social settings that he or she really enjoys.
After establishing goals and objectives based on prioritized needs, the next step is to design an
intervention plan for the development (i.e., acquisition, mastery, and generalization) of skills in the following
areas:
• Core skills: nonverbal social interaction, imitation, organization, and self-regulation skills
• Social skills: play and leisure, group, and social perspective-taking skills
• Communication skills: basic communication, socioemotional, and basic conversational skills
• Community skills: community outings, family outings, and school or work activities and safety
Frameworks for designing intervention will be discussed in each of these skill areas in the following
sections.

FRAMEWORK FOR INTERVENTION: CORE SKILLS

Teaching children with autism nonverbal social interaction and imitation skills lays the foundation for later
social and communication development. Planning intervention to build these core skills is critical. Children
who possess splinter skills and lack the prerequisite core foundation skills may acquire rote, isolated, and
inflexible skills that are difficult to generalize in natural contexts. The plan to expand the repertoire of core
skills for a child with autism must include decisions about what core skills to teach and how to design
intervention to teach those skills.

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How to Design Intervention to Teach Core Skills
Some foundational steps for teaching skills are presented in Figure 4.5:

Figure 4.5. Framework for building core skills.

• Provide meaningful and motivating learning opportunities.

• Use systematic instruction.
• Scaffold skill sequences.
Structure Learning Opportunities When teaching, assume that every moment is an opportunity to build
nonverbal social interaction and imitation skills. At school, this could be morning meeting, music time, and
recess. At home, this could be bath time, mealtime, and travel time in the car. It is essential that there are
meaningful and motivating opportunities across the day. For example, teach the child to point to a favorite
food item during mealtime. Create opportunities to practice skills through highly engaging activities (e.g.,
music, movement), taking into account the child’s level of motivation. If an adolescent is motivated by Star
Wars, set up learning opportunities that incorporate his or her special interests. Whenever the child is
unmotivated by the activity or setting, contrive or set up opportunities for interaction to occur by embedding
motivators into the setting. For example, if a young child is not interested in imitating actions during a
movement activity but is motivated by Disney characters, then include images of the Disney characters “doing
the actions” to build the target imitation skill. Or, transform a simple puzzle activity that the child enjoys into
opportunities to practice requesting by placing puzzle pieces in sight but out of reach so that the child has to
request the items. The ultimate goal is to maximize the use of natural contexts to ensure ease of skill mastery
and generalization. Whenever possible, teach skills in the actual environments in which the child requires the
skills. For generalization to occur, provide numerous opportunities for the child to demonstrate skills in novel
contexts.
Use Systematic Instruction When teaching, use systematic instruction to build nonverbal social interaction
and imitation skills. With systematic instruction, children acquire new skills through direct instruction and
then learn to apply those skills in novel, meaningful contexts. Some of the steps in systematic instruction are
1) directly teach new skills in one or more settings, 2) structure interactions to elicit emerging skills in familiar
settings, 3) systematically fade prompts to promote spontaneous skill use in familiar settings, 4) elicit mastered
skills in novel settings, and 5) ensure generalization and functional use by practicing and applying skills in
multiple contexts. For example, after a teacher has taught a student to respond to a greeting with a wave, the
teacher might enlist a peer to wave and then prompt the child with autism to return the peer’s wave.
Eventually, the teacher would fade the structure and the prompting to ensure generalization and functional
use of “responding to a greeting” across multiple adults and peers in a variety of settings.
Systematically Scaffold Skills When teaching, systematically scaffold existing skills to build increasingly
more complex nonverbal social interaction and imitation skills. With scaffolding, instruction is aimed at
helping students gradually achieve more complex skill levels. A task analysis can be completed to break a new
skill into discrete or single steps. Each step is then prompted, with support eventually faded during the
learning process. During the process of scaffolding instruction, a child might first be encouraged to use single
nonverbal signals or imitative acts before combining multiple nonverbal means of interaction or imitative acts.

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For example, when teaching how to greet with a wave, first teach and reinforce the child for raising his hand.
Second, teach and reinforce the child for raising his hand and moving it side to side. Third, teach and
reinforce the child for looking at his partner and then raising and waving his hand. Similarly, when teaching
how to imitate motor actions, begin with teaching and reinforcing the child for imitating a single motor
action (e.g., stand up) and then teach a sequence of actions that might logically occur (e.g., stand up, turn
around, sit down). The ability to imitate a logical sequence of three or more motor actions mirrors the skills
necessary for watching and imitating others in natural settings.

Deciding What Core Skills to Teach

When planning interventions to increase core skills, always begin with assessment data, such as ASCS-2
results, and use the results to prioritize what core skills would be most beneficial for the child to acquire. Core
skills, especially nonverbal social interaction, imitation, and self-regulation, play a critical role for all aspects of
social and communication functioning.
Nonverbal Social and Communication Skills Nonverbal social interaction is a critical milestone in the
development of social and communication skills. Nonverbal interaction encompasses a wide range of gestural
and affective means of expression that is used to initiate and respond in social interactions, to engage in
reciprocal turn taking in order to make basic requests, and to share interests with others. Eye gaze, gestures,
and facial expressions can be expressed in isolation (e.g., reach for an object) or in combination (e.g., combine
eye gaze and a gesture to indicate a desire for an object). The ability to coordinate attention among oneself,
social partners, and an object (i.e., joint attention) is more complex than the ability to use one nonverbal
means in isolation. Joint attention involves the ability to follow another person’s visual line of attention, the
ability to coordinate eye gaze and gestures with another person, and the ability to use eye gaze and gestures to
direct another person’s attention to events or objects.
Teach skills that focus on the use of a single nonverbal social–communicative means (e.g., looking at
object when directed) before combining multiple nonverbal means within social interaction (e.g., looking at
object when directed and then looking back at person). It is essential that nonverbal skill development be
addressed in children both with and without language skills, because word use without nonverbal social
interaction skills is common in autism. Target skills that the child is lacking or displays in limited contexts,
such as social attention (e.g., looking at person or object when directed), social regulation (e.g., using one or
more gestures to request), and joint attention (e.g., using one or more nonverbal means to share interests).
The intervention plan should include goals to
• Expand the repertoire of nonverbal social–communicative interaction skills
• Expand the ability to persist with nonverbal social communication
• Expand the ability to combine two or more nonverbal social–communicative behaviors
• Generalize skills to interactions with multiple individuals, including both adults and peers
• Generalize skills across multiple contexts
The child with autism becomes effective in social interactions when he or she can combine social
behaviors in an effort to be understood by others and achieve an intended goal. The ability to combine
multiple nonverbal means of communication is central to the development of effective social–communicative
reciprocity. Keep in mind that nonverbal social–communicative skills are not a hierarchy of skills; rather, all
areas should be addressed systematically and simultaneously.
When building core skills, it is important to identify the possible communicative function of a child’s
idiosyncratic behaviors and replace them by teaching more conventional means of communication.
Idiosyncratic behaviors, such as restricted and repetitive behaviors, are those actions that carry meaning for the
individual and those familiar with how the behavior originated. For example, a child may flap his hands to
signal that he is stressed. This unconventional gesture, viewed by some as a challenging behavior, is actually
nonverbal communication. Assigning communicative intent to the behavior helps the child to learn the
purpose of communication and allows the intervention team to target a replacement skill, such as requesting a
break or refusing an activity in a more conventional way. The following vignette illustrates nonverbal core skill
challenges.

Jordan does not direct gestures or nonverbal or verbal behaviors toward others to seek help. If he has difficulty opening
a cookie container, he bites it, bangs it, cries, and eventually disregards it. These behaviors occur even when another
individual is sitting next to him. In this context, his behaviors reflect an absence of communicative intentionality. He

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will walk into the kitchen and say, “Do you want some juice?” even if no family members are nearby. His message has
meaning and he is seeking a specific outcome, but there is an absence of communicative intent.

Imitation Skills Imitation is a critical milestone in the development of social and communication skills.
Early development of imitation progresses from repeating motor and vocal actions to copying novel actions
and then to social acts such as waving and multiple actions with objects. Typically developing children imitate
a sequence of novel actions, invisible acts (i.e., actions they cannot see themselves do), and actions observed in
others at an earlier time (i.e., deferred imitation).
Target imitation skills for instruction with the understanding that children with autism may vary
significantly in their ability to imitate others. In the absence of social attention, imitation does not occur. For
some children with autism, sequencing a series of motor actions (i.e., motor planning) can be challenging.
Furthermore, often there is a significant difference between the child’s ability to imitate spontaneously in
natural contexts and his or her ability to imitate elicited actions in structured contexts. The following vignette
illustrates the importance of structure in teaching imitation to children with autism.

Ayden enjoys music. Motor and vocal imitation were elicited in the context of structured music games with his teacher.
He was seated across from his teacher for the activity. For each song, he and the teacher had one object to move. They
shook a bell for song 1, raised a pom-pom up and down during song 2, and moved a puppet on and off their knees
during song 3. Ayden was required to attend to the teacher and imitate the one action with one toy during each song.
Interest motivated his successful imitation.

Some children with autism are able to apply imitation skills to natural contexts, whereas others show
considerable variability in spontaneous imitation. Teach motor and verbal imitation skills that the child is
lacking or displays in limited contexts. In the area of motor imitation, be sure to consider developmental
milestones when prioritizing goals and objectives. For example, it is easier for a child to imitate a single action
with an object than to use his or her body to imitate a fine-motor action such as clapping. Similarly, it is easier
to imitate large-motor movements, such as running, than to imitate fine-motor actions. With these
developmental considerations in mind, priority goals should address the child’s ability to
• Imitate actions with objects
• Imitate a sequence of motor actions with and without objects
• Spontaneously imitate motor actions in natural contexts
• Generalize motor skills across multiple novel contexts
• Generalize motor skills to interactions with multiple individuals
Unlike motor imitation, which can be prompted and scaffolded, verbal imitation is more difficult to elicit.
Therefore, priority goals in the area of verbal imitation should address the child’s ability to
• Imitate vocalizations/verbalizations in highly motivating contexts
• Spontaneously imitate verbally in highly familiar motivating contexts
• Generalize verbal skills across multiple familiar contexts
• Generalize verbal skills to interactions with multiple adults and peers
The following vignette illustrates a sample core skills intervention plan.

Using assessment data, the intervention team learned that Meredith does not demonstrate many core skills. The team
has written a goal to increase Meredith’s nonverbal interaction and imitation. The team identified two specific
objectives in the area of nonverbal interaction and two specific objectives in the area of imitation. Specifically,
Meredith will…
1. Tap an adult’s wrist to initiate social interaction
2. Point to desired items in view but out of reach
3. Imitate five different motor actions
4. Imitate vocalizations during familiar routines
The team then identified five activities that Meredith enjoys and that routinely occur during the school day. These
five activities were the context to teach and practice the four target skills every day:

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 1. Mealtime
2. Small-group music
3. Playground
4. Puzzles
5. Technology with sing-a-long animated books
The team then identified 1) how many times Meredith would be prompted to use the two nonverbal
communicative requests during each activity and 2) what specific actions and vocalizations would be targeted for
imitation during each activity. The information was summarized and shared with all adults who interact with
Meredith at school and in her home.

FRAMEWORK FOR INTERVENTION: SOCIAL SKILLS

Teaching children with autism discrete social skills can begin to contribute to their increased understanding of
social activities, which are complex, dynamic, and constantly changing. Social activities require the ability to
understand the meaning of multiple contextual, language, and socioemotional events. The requirements of
social interaction sharply contrast with the learning patterns associated with autism, characterized by
challenges in understanding and using social information in a flexible manner. This limits the development of
dynamic social relationships and creates a paradox for building social skills in children with autism. Figure 4.6
represents the dynamics of social activities that require the ability to simultaneously “DO and WATCH and
LISTEN and SAY.”

Figure 4.6. Social participation in typically developing individuals.

Social activities require the ability to DO-WATCH-LISTEN-SAY in a flexible, integrated manner

within a specific social context. The DWLS framework correlates with the following capacities:
• Cognition—the ability to know what to DO
Children actively use objects and materials in the physical environment and learn through experience.
Exploration contributes to an understanding of how things are related.
• Social awareness—the ability to WATCH others
Children observe and imitate others. Observation contributes to an understanding of how to imitate, share
(e.g., physical space, objects), and take turns and contributes to understanding others’ nonverbal social
behaviors (e.g., gestures, emotional displays).

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• Language—the ability to LISTEN
Children listen to others. Listening contributes to an understanding of language meaning assigned to the
objects in the environment, the individual’s own activities, and the verbal and nonverbal activities of
others.
• Communication—the ability to know what to SAY
Children initiate and maintain reciprocal interactions. Communication contributes to sharing messages
that are relevant to the social context, one’s own needs and interests, and the needs and interests of others.
Virtually every social activity with others requires the ability to simultaneously and flexibly DO,
WATCH, LISTEN, and SAY. Typically developing children flexibly engage in these four domains of social
activities. Table 4.3 illustrates how this ability is observed in two different social situations: social play and a
community activity.

Table 4.3. Applying the DO-WATCH-LISTEN-SAY framework to two activities

Ability Social play activity: Building blocks with peers Community activity: Going trick-or-treating on Halloween
Do Use the blocks in exploratory, functional, or creative ways. Put on a costume, carry a bag, walk from house to house, ring the doorbell, and
put candy in the bag.
Watch Observe peers’ play, socioemotional behaviors, and nonverbal requests; share blocks; take Observe activity of others, stay with the group, wait as needed, take turns, accept
turns; and cooperate on a building project. candy, and interpret nonverbal social messages.
Listen Listen to what is said during the activity, such as peers’ verbal requests and comments. Listen to information given to the group, such as questions and directions (e.g.,
verbally or nonverbally).
Say Initiate and maintain reciprocal communicative interactions and respond to peers’ verbal Know what to say and when, including “trick-or-treat,” “thank you,” and “bye”
requests/comments. (e.g., verbally or with a gesture), and respond to questions.

In contrast, children with autism can have trouble integrating what to DO, whom to WATCH, how to
LISTEN, and what to SAY. Because of cognitive and social processing constraints, they may show less social
flexibility and more fragmented social behaviors. In social settings, they are more likely to focus their attention
on one of the four domains and struggle when shifting from one domain to the other. For example, they may
focus their attention only on what to DO or what to SAY and demonstrate difficulty combining cognitive,
language, social, and communication elements. Often, their acquisition of social skills progresses from one
domain to the next in a linear, fragmented fashion (see Figure 4.7). Children with autism often

Figure 4.7. Social participation in individuals with autism.

• DO then/or
• WATCH then/or
• LISTEN then/or
• SAY
Children with autism may master different aspects of a social activity but be unable to integrate the
cognitive (DO), social (WATCH), language (LISTEN), and communication (SAY) requirements of fluid
social interaction. The following vignettes illustrate various challenges with integrating the components of a
particular social activity: playing with blocks.

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Jeremy is verbal. He rarely observes the activities of others and he does not imitate others. When he plays with blocks,
he focuses all of his attention on the properties of the blocks but has complete disregard for others. He lines up the blocks
(DO), counts them repeatedly, and becomes upset whenever another person interrupts his play.

Brenda is verbal. She observes peers’ activities in highly motivating situations. She enjoys blocks. When alone, she
builds elaborate structures. When in the block area with peers, however, she spends most of the time watching the play
of others (WATCH). She collects blocks and waits for a peer to request one from her (LISTEN). Although she talks
about her play activity when alone, she is quiet when with peers. She can only focus her attention on the social
behaviors of others and cannot coordinate their behavior and her own.

Ned is nonverbal. He observes and imitates adults and peers from time to time during play. When he is playing blocks
with peers, he builds towers (DO) and intermittently watches peers and shares toys and space (WATCH), but he does
not respond to the verbal or nonverbal bids of others. He does not respond to peers when they call his name, ask a
question, or indicate that they want him to join their play.

Tyler is verbal. He frequently observes and imitates peers during play. Whenever he is playing blocks with peers, he
builds a structure (DO) and joins his peers in building the structure, shares, takes turns, and imitates (WATCH). He
also nonverbally replies to the requests of his peers, such as responding when they ask him to play or when they ask him
for another block, and joining in their laughter (LISTEN). Although he can engage in verbal interactions with adults,
he is unable to initiate or respond verbally with his peers.

As these examples illustrate, children with autism can possess various levels of social success in an activity.
Social success is defined as the ability to DO-WATCH-LISTEN-SAY within a specific social context. An
understanding of these four aspects of every social activity is useful for planning social skills intervention.
Using the DWLS framework, the four children playing with blocks would have different target goals and
objectives:
• DO: The goal for Jeremy, who is narrowly focused on lining up and counting blocks, might be to increase
his functional use of objects. The objective could be more specific and written in the context of functional
use of blocks.
• WATCH: The goal for Brenda, who had trouble coordinating her play with others, might be to increase
her turn-taking skills. The objective could focus on turn taking while building with blocks.
• LISTEN: The goal for Ned, who does not respond to others, might be to increase his responses to
nonverbal initiatives. The objective could focus on responses to peers.
• SAY: The goal for Tyler, who does not respond verbally to peers, might be to increase his verbal
interactions. The objective could focus on talking with peers.

Social Skill Development and the DO-WATCH-LISTEN-SAY Framework

The design of intervention for solitary play and leisure, social play and leisure, group skills, and community
skills can be built on the DWLS framework. The framework begins with a specific setting or activity and an
analysis of the various cognitive (DO), social (WATCH), language (LISTEN), and communication (SAY)
skills that are required for full participation. An understanding of these four aspects of every social activity is
useful for planning intervention. To assist children to meaningfully engage in a social activity, a task analysis
can help determine the skills needed to ensure success with all four aspects of the activity. A task analysis
involves breaking an activity into smaller discrete components in order to teach every step of the activity.
When setting a goal to teach a specific skill, a task analysis helps determine the best contexts in which to
address the skills. As the smaller components are mastered, the individual becomes more and more
independent in his or her ability to perform the larger skill. Other behavioral practices, such as those discussed
in Chapter 5 (e.g., modeling, prompting, time delay, reinforcement), can be used to facilitate the learning of
each step.
Conducting a task analysis based on the DWLS framework contributes to an understanding of the social
dynamics within skills and activities. Figure 4.8 is a task analysis guide that uses the DWLS framework,
which allows an understanding of both the interwoven and the sequential components of an activity. In other
words, the social task analysis can be used to identify the variety of cognitive (DO), social (WATCH),
language (LISTEN), and communication (SAY) skills that are interwoven into the sequential steps of a social
activity from beginning to end.

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Figure 4.8. DO-WATCH-LISTEN-SAY social task analysis guide.

The task analysis creates a list of the steps of a social activity and categorizes the requirements of an
activity into the domains of DO-WATCH-LISTEN-SAY. Once the list of skills required during an activity
is identified, then the team completes the Social Task Analysis. Using direct observation during the activity,
data are collected on how a child performs in order to determine what skills and abilities are lacking in each
domain and preventing his or her successful participation in the social activity.
After identifying the specific skills needed within a specific activity, plan social skills intervention (see
Figure 4.9) with the following considerations:

Figure 4.9. Social skills intervention planning using the DO-WATCH-LISTEN-SAY framework.

• Categorize skills (i.e., as DO, WATCH, LISTEN, or SAY).

• Follow the general progression of skills within each of the four domains; first teach the child to DO and
WATCH, then teach the child to LISTEN and SAY.

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• Consider the presence or absence of core skill abilities, recognizing the importance of nonverbal social
behaviors and imitation skills for social success, in the selection of instructional strategies (to be discussed
in Chapter 5).
• Consider social partners, recognizing that successful interaction with adults often precedes successful
interactions with peers.
Categorize Skills First, information from the task analysis can be used to identify and categorize the skills
needed in a social activity into the domains of DO-WATCH-LISTEN-SAY. This general hierarchy is built
on the belief that the child with autism learns
• First: what to do and whom to watch
• Then: how to listen, respond to others, and initiate communication; and finally what to say
When teaching a child with autism, the skills needed to participate in a social activity, be cognizant of this
general progression of abilities within the DWLS framework so that it is clear what abilities the individual
possesses and how to build on them.

Follow Progression Second, apply the DWLS framework to each individual social activity, recognizing
the general progression of skills within each of the four domains when deciding which skills to teach (see
Figure 4.10):

Figure 4.10. DO-WATCH-LISTEN-SAY skill progression.

• DO: Within this domain, an individual first engages in functional closed-ended activities, then in
functional open-ended activities, and later in creative activities.
• WATCH: Within this domain, an individual first learns to share space, then to follow the social cues of
others, and finally to engage in back-and-forth turn-taking interactions.
• LISTEN: Within this domain, the individual first responds to nonverbal gestural messages of others, then
to nonverbal prosocial behaviors, and finally to verbal messages.
• SAY: Within this domain, the individual first initiates nonverbal prosocial messages and then nonverbal
requests or comments. Later, the individual initiates verbal prosocial messages and then verbal requests or
comments, with the final goal of maintaining a conversational exchange.
Consider the Influence of Core Skills on Social Skills Third, take into account the child’s core skill abilities
when planning social skills intervention. The presence or absence of social observation and imitation skills
dictates the selection of strategies. For instance, a child who observes and imitates would benefit from another
person modeling the skill, whereas someone who does not observe or imitate might require an alternative
strategy such as being prompted to perform the skill. A child who is organized and self-regulated in a

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particular setting may benefit from more traditional instructional strategies, whereas a child who is not
organized or self-regulated might require more individualized instructional supports.
Consider Social Partners Finally, consider social partners when planning social skills intervention. It is
common for children with autism to master social skills with adult and sibling partners before generalizing the
skills to peer partners. This distinction is largely because the adult social partner or family member is better
equipped to understand the social efforts of the child with autism and to adapt the interaction to enhance
success. Planning for successful interactions with peers requires a close look at which activities the child has
first mastered with an adult or sibling partner.

Design Intervention for the Development of Solitary Play and Leisure Skills
Teaching children with autism to engage in enjoyable, meaningful, and socially appropriate solitary play and
leisure activities is central to intervention planning. The plan must include decisions about which solitary skills
to target and how to teach “what to DO.” To determine which solitary play and leisure skills to select for a
particular child, examine his or her interests, skills, and level of independence using an assessment such as the
ASCS-2 (see Chapter 3 Appendix). Target goals and objectives that are focused on increasing solitary play
and leisure using a progression of skills. This might include progressing from functional use to creative use of
materials or from engaging in closed-ended to more open-ended solitary play and leisure activities.
Intervention to foster solitary play and leisure skills must take into account the critical elements of solitary play
observed in typically developing individuals. For example, observe how long a same-age peer is able to occupy
him- or herself in a play and leisure activity to indicate a length of time that may be reasonable for a child with
autism.
How to Design Intervention to Teach Solitary Play and Leisure Skills The plan to expand an individual’s
repertoire of solitary social skills must include decisions about how to design intervention and what to teach.
To increase and expand solitary play and leisure skills
• Build on the child’s interests and sensory preferences
• Expand the child’s current repertoire of solitary play and leisure skills
• Increase the child’s level of sustained attention and independence when engaging in play and leisure
activities alone
Build on Interests and Sensory Preferences Solitary play and leisure skills can be increased by building on the
child’s interests and preferences. The ASCS-2 helps to identify unique interests and gain insight into which
activities the child finds meaningful enough to participate in and spend time doing. The child’s unique
restricted and repetitive behaviors, both with his or her body and with objects, can provide insight into which
motivating activities and sensory preferences to introduce:
• If a child enjoys puzzles, introduce other manipulative activities.
• If a child likes using playground equipment, introduce additional physical activities.
• If a child has a limited repertoire of interests, examine the qualities of activity preferences and introduce
activities that provide the same visual, auditory, tactile, or movement feedback. For instance, if the
individual enjoys watching objects move, introduce activities that provide visual feedback (e.g., a marble
run, ball play, beanbag toss).
• If a child engages in object restricted or repetitive behaviors to produce sound (i.e., shaking objects to hear
a repeated sound), introduce solitary activities with auditory elements, such as listening to music with
headsets or playing the piano.
See Table 4.4 for some ideas on how to expand play and leisure for children with fixed or specific interests.

Table 4.4. Creative ways to expand play and leisure interests

Interests Ideas for play and leisure
Spinning the body
Select activities that provide multiple ways to spin your body. Dance
Gymnastics equipment
Tumble
Cartwheels
Parachute games
Music with movement
Exercise videos
Hokey-Pokey
Merry-go-round
Ring around the Rosie
Kite
Playground ride
Spinning objects

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Select materials and activities that spin in multiple ways or have spinning parts. Twirling top toy
Music boxes
Sand wheel
Water wheel
See ’n say
Toys with spinning parts
Jack-in-the-box
Board game spinner
Spin art
Gears
Kaleidoscope
Computer games
Yo-yo
Cooking mixer
Helicopter
Race track and cars
Toy trains
Marble run
Dreidel
Pinwheel
Rotating water sprinkler
Numbers or alphabet letters
Select materials and activities that contain numbers or alphabet letters that can be used in multiple Magnets
ways. Puzzles
Sponge shapes
Magnetic letters
Beanbag toss with alphabet or number frame
Letter- or number-shaped cookie cutters for playdough
Vinyl clings for windows
Lotto games
Scrabble Junior
Tracing
Computer games
Alphabet cards by theme
Paint-by-numbers
Spell or count during any social interaction
Stickers
Board games
Books with alphabet and number themes
Calculators
String beads by number pattern
Calendar activities
Toy vehicles with words or numbers on them
Dress-up hats with words or numbers on them
Academic activities with words or numbers
Play music by following a numbered music sheet
Captioned videos
Chalk for writing outside
Spelling items during game or activity
Hopscotch
Boggle or Scrabble
Dot-to-dot number puzzles
Writing
Keyboarding
Playing cards
Music with alphabet songs
Alphabet 1-inch blocks
Clocks
Money games
Name cards
Cooking recipes
Sorting activities
Matching activities
Count items while playing
Piano with numbers on keys
Alphabet or number stamps
Stencils
Animals
Select toys and activities that contain animals that can be used in multiple ways. Sort animals
Count animals
Visit a farm or a zoo
Cut stripes and spots for tigers and leopards
Follow the Leader as different animals
Movement games—act as a specific animal
Animal puzzles
Make paper bag animals
Animal masks
Hide a toy animal in the room and follow eye gaze to find
Wash animals
Vet, farm, zoo, or jungle dramatic play center
Yoga animals
Animal books
Animal matching cards
Animal crackers: sorting, counting, and eating
Make lily pads and hop to the pads like frogs
Match baby animals and parents
Match animals and their food
Act out animal stories (e.g., Henny Penny, The Gingerbread Man)

Expand on Existing Play and Leisure Skills Solitary play and leisure skills can be increased by building on
the child’s current skills. Observe whether the child is able to use objects and materials functionally or
creatively when selecting solitary play and leisure activities. Objects and activities are inherently structured or
closed-ended and unstructured or open-ended (see Table 4.5).

Table 4.5. Closed-ended and open-ended activities

Closed-ended activities (structured): Easiest Open-ended activities (unstructured): More difficult
Performed in one functional way Performed in creative ways
Materials have a distinct purpose Materials used in multiple ways
Activity has a clear completion End of activity is arbitrary
Set number of materials and steps No sequence of steps
Activity purpose is clear and predictable Activity purpose is not organized or predictable
Examples: Looking at books requires one material and one step, and constructing models requires Examples: Using the sandbox, building blocks, and playing with dolls require creative use.
multiple materials and a fixed sequence of steps.

Given the learning style of children with autism, it is recommended that closed-ended activities be first

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selected for solitary play and leisure. Closed-ended activities consist of objects and activities that are used in
one functional way and are inherently organized. Closed-ended activities that are done in the same way each
time are more rule based than creative in nature. Individuals with autism may prefer closed-ended activities
because the materials have a distinct purpose and the activity is predictable. Open-ended activities consist of
objects and activities that can be used in a variety of ways and lend themselves to creative use. Table 4.6
provides ten categories of play and leisure with sample activities. The first eight categories are useful for
building solitary play and leisure skills. The table provides examples of closed-ended and open-ended play for
each category of play and leisure.

Table 4.6. Categories of play and leisure activities

Category Examples of play and leisure objects and toys Structure
Exploratory Cause-and-effect toys, wind-up toys, kaleidoscope Closed-ended
Sand, water, snow, rocks Open-ended
Physical Bicycles, roller skates, swings, playground Closed-ended
Sports games with clear roles and rules Closed-ended
Manipulative Puzzles, pegboards Closed-ended
Playdough Open-ended
Constructive Lego models, train tracks Closed-ended
Legos, blocks, building materials Open-ended
Art Stencils, paint-by-numbers Closed-ended
Drawing, collage, painting Open-ended
Literacy Books, audio books, computer, video games Closed-ended
Sociodramatic Theater, mime Closed-ended
Dress-up, play with miniature figures, dolls, animals Open-ended
Music Listening to music, playing an instrument Closed-ended
Singing, dancing Open-ended
Games Board games, card games Closed-ended
Social games Games with rules (e.g., Hide-and-seek, chase) Closed-ended

Increase Attention and Independence Solitary play and leisure skills include the ability to sustain attention for
a specified period of time. Motivation to play and understanding what to do with objects and materials largely
determine the child’s level of engagement and independence. Activities that are both fun and meaningful to
that particular individual increase attention and independence. Often, it is necessary to directly teach object
use and work to systematically increase sustained engagement and independence in solitary play.

Consider the Influence of Core Skills on Solitary Play and Leisure Skills A variety of approaches—ranging
from highly structured teaching to naturalistic intervention—are available to teach a child with autism what to
do when engaged in solitary play and leisure activities. An individual’s specific learning characteristics and
other factors such as social observation skills, motor imitation skills, organizational skills, and restricted and
repetitive behaviors must be considered when planning intervention. The steps taken to build solitary play and
leisure skills are driven by this information, because the core abilities to observe others, imitate others, and
remain organized determine the selection of strategies. For example, naturalistic approaches such as modeling
can be used to expand play and leisure skills if the child demonstrates core skills. As this is the most natural
way to build play and leisure skills, it also is sometimes the easiest. If the child does not demonstrate one or
more core skills or exhibits restricted and repetitive behaviors with new materials, structured and systematic
supports such as organizational supports, social supports, communication supports, and behavioral supports
are needed. These will be described in Chapter 7. The following summary list suggests how to enhance
solitary play and leisure in a way that is tailored to each person’s specific abilities:
• If the child demonstrates social observation skills and social imitation skills, emphasize modeling
strategies.
• If the child lacks social observation or social imitation skills or engages in restricted and repetitive play,
emphasize structured teaching and systematic support.
• If the child has challenges with auditory processing or receptive understanding, limit the use of verbal
instruction.

The following vignettes describe how solitary play and leisure skills were taught to three different children
with autism. Each individual required different supports for the acquisition of solitary play skills.

Jeff engaged in numerous restricted and repetitive behaviors, did not possess social observation and imitation skills,
and had poor organizational skills. Closed-ended solitary play and leisure tasks were selected, and independence was
taught with organizational supports. A specific area at home was identified for solitary leisure activity. Jeff’s activity
materials were organized in see-through boxes and labeled with pictures. For example, one box contained a crossword
puzzle and pencil, another contained an electronic device with audio book, and a third box contained a coloring book
page and crayons. A picture sequence of the different items was placed on a choice board. Jeff was taught to make a

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choice, get the correct box, open the box, complete the activity, put the materials and the picture back in the box, and
then select another activity from the choice board. Jeff’s choice board grew from two to eight activities, and his length of
independent activity time increased from 5 minutes to 20 minutes.

Louis had excellent social observation skills but lacked imitation skills. He also had a number of functional play and
leisure skills but was very disorganized and engaged in restricted and repetitive behaviors when presented with open-
ended materials. Louis was taught new play and leisure skills through the use of adult modeling and visual cues. His
teacher developed a simple picture book that depicted the various ways certain activity materials could be used. She read
the book and modeled the activity in a fixed, sequential order. After watching his teacher read and model the activity,
Louis acquired the skill with minimal adult prompting and used the book to guide his activity. Through this method,
Louis acquired a new open-ended play activity each month. Gradually, with his own mastery of the materials, his play
and leisure behavior shifted from scripts to flexible toy use.

Teddy enjoyed reading and engaging with manipulatives, although his ability to sustain attention was limited. The
solitary play and leisure activities chosen for Teddy were Lego models, color-by-number paintings, word-find books,
and audiobooks. A special place was organized for Teddy for independent activity, and a written checklist of choices
was provided for him. A timer was used to specify the length of his independent play and leisure time. After 20 minutes
of independent activity, he was provided time to watch a video. This reinforcement, as well as the use of
organizational supports, helped Teddy engage in solitary play and leisure for extended periods of time.

Design Intervention for the Development of Social Play and Leisure Skills
Teaching children with autism to interact with peers is critical for social success. The plan must include
decisions about what social skills to target and how to teach “what to DO,” “whom to WATCH,” “when to
LISTEN,” and “what to SAY” across a variety of social play and leisure activities. Intervention that maximizes
the child’s ability to share materials and observe others’ social behavior is a critical beginning. The ability to
respond to the nonverbal and verbal overtures of peers is equally important.
The selection of goals and objectives to increase participation in social play and leisure activities should
take into account the complexity of the specific social activity. The ASCS-2 assessment includes a progression
of social play and leisure that is related to the DWLS framework. As with solitary play, intervention to foster
social play and leisure skills in children with autism must take into account the various dimensions of the
social activities observed in typically developing children. A task analysis of a social activity can clarify essential
versus optional elements. For example, observe how much the ability to participate in a social activity depends
on taking turns (WATCH) or determine whether conversation (LISTEN-SAY) is required or optional in a
particular activity. The plan to expand the repertoire of social skills must include decisions about how to select
specific social activities and then determine the sequence of skills to teach.
How to Design Intervention to Teach Social Play and Leisure Skills Overall, intervention to teach social
play and leisure will enhance a wide range of cognitive, social, language, and communication skills; teach
social understanding; increase social competence; and facilitate generalization of social skills across a variety of
play, non-play, and leisure settings. To increase and expand social play and leisure skills,
• Build systematically on the general DO-WATCH-LISTEN-SAY skill sequence
• Organize the dimensions of each social activity
• Expand the child’s current play and leisure skills within each activity
• Systematically select and support peer social partners

Build on the DO-WATCH-LISTEN-SAY Skill Sequence Successful intervention to increase social play and
leisure skills can be influenced by following the DO-WATCH-LISTEN-SAY skill sequence:
• Expand the repertoire of social play and leisure activities by selecting activities that the child knows how to
DO independently and target social skills within the domains of WATCH and LISTEN.
• Start with closed-ended, rule-based activities that allow for parallel participation during social intervention
before introducing activities that require sharing and turn taking.
• Focus on mutually enjoyed objects and activities to foster peer acceptance during social experiences.
• Maximize opportunities to observe others’ social behavior, because this is a critical beginning to increase
the child’s ability to respond to peer overtures.

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• Teach social responsiveness to peers more than promoting initiations at the beginning stages of social skill
intervention.
• Teach the use of nonverbal social behaviors with peers more than the use of verbal behaviors at the
beginning stages of social skill intervention.
In the domain of DO, the primary goal is to ensure that the child understands what to do before being
placed in the social situation. That is, the child should demonstrate meaningful (e.g., functional, creative)
solitary play and leisure with objects and materials. A level of familiarity with the objects and materials in an
activity is an important consideration when selecting social play and leisure activities. Start with closed-ended
and rule-based play and leisure activities that allow for parallel participation during social intervention before
moving to more open-ended activities. Activities that the child has mastered with adults can be used to
enhance peer interactions, because social skills are typically acquired through interactions with adults before a
child is able to generalize the skills to peer play and leisure activities. Focus on activities that are mutually
enjoyed by the child and his or her peers.
In the domain of WATCH, the primary goal is to provide opportunities for the child to share physical
space, share materials, and take turns interactively, because these are important skills for social success. First,
support the child in sharing physical space with others. In activities requiring this skill, provide the child with
highly motivating materials while he or she plays in proximity to peers. To share space successfully, the
individual must be able to organize him- or herself and self-regulate to remain calm but alert in the
environment. Second, support the child in parallel, side-by-side play with a peer, and each individual should
have his or her own highly motivating set of materials. Third, structure a play and leisure activity so that the
child understands what specific objects and materials to share with peers. In this stage, the child shares focus
and mutual attention with the peer on a highly motivating activity. Later, organize cooperative play and
leisure activities to facilitate sharing and turn taking by selecting highly motivating activities that require
reciprocal exchanges and engagement.
In the domain of LISTEN, the primary goal is to foster nonverbal social behaviors and nonverbal
communication skills. Comprehending the nonverbal qualities of peer interactions is important for social
success. Verbal interactions with peers should be secondary when beginning intervention. The primary
objective is for the child to respond to the overtures of peers. In addition, start by placing more emphasis on
teaching social responsiveness to peers rather than initiating social interactions. The use of nonverbal
communication skills should be a primary intervention goal, and verbal interactions with peers should be
secondary.
Several studies have reported success in teaching positive prosocial behaviors—such as sharing objects,
giving nonverbal compliments, and responding to peers’ overtures—to children with autism (Greenway, 2000;
Wolfberg, 2009). To teach positive prosocial behaviors, target clear goals and then organize the activity to
create a more meaningful play experience, build on the individual’s core skills, and support peer social
partners.
Consider All Dimensions of the Social Play and Leisure Activity Successful participation in social play and
leisure is influenced by the complex dimensions of an activity. Table 4.7 provides the dimensions of social
activities to be considered and compares the characteristics of easy versus more complex play and leisure
activities. These eight dimensions include the structure and predictability of the activity, the group size and
structure, the organization of objects and materials, and the social and language requirements.

Table 4.7. Dimensions of social play and leisure activities

Social play and leisure activities
1. Activity structure: Closed-ended or open-ended?
2. Social predictability: Predictable role for each individual or not?
3. Group structure: Unison or turn taking?
4. Group size: Small or large number of partners?
5. Materials: One, a few, or many materials?
6. Sharing: Not required or required?
7. Listening: Not required or required?
8. Speaking: Not required or required?
Easier play and leisure activities More complex play and leisure activities
Are closed-ended Are open-ended
Predictable events Unpredictable events
Peers doing the same thing at the same time Peers doing different things at different times
Small group size Large group size
Use limited objects and materials Use multiple objects and materials
Require no sharing, turn taking, or waiting Require sharing, turn taking, and waiting
Require no listening Require listening
Require no language Are language based

Social play and leisure activities range in complexity according to the aforementioned social, language, and
communication features. The easiest social play and leisure activities require the child with autism to only DO
something near others, whereas the most complex activities require the child to DO-WATCH-LISTEN-

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SAY. It is important to examine the child’s play and leisure skill preferences and interests, always starting with
a highly motivating activity or objects and materials. Closed-ended activities are inherently more organized
and thus contribute to greater success. To increase social participation, organize play and leisure activities so
that the child clearly understands what to DO, what materials to share, and when to take a turn. Both the
number of peers and the social complexity of the group can contribute to the child’s understanding and
participation.
To build successful social skills and facilitate interactions with others, examine the requirements and the
task demands of the social activity. A distinction needs to be made between activities that require a specific
skill and activities in which the use of that skill is optional. For example, some activities may include
conversation, but not all do. Similarly, sharing may be an option but may not be required in a particular
activity. Activities that require reciprocal conversation for participation may be the most challenging for
individuals with autism.
Support Peer Social Partners Successful participation in social play and leisure also is influenced by the
skills of the social partners. Peer-mediated instruction and intervention, more commonly referred to as peer
supports, is an EBP that involves teaching peers ways to engage children with ASD in meaningful social
interactions (Wong et al., 2013). Peers may need to modify their manner of initiating and maintaining
interactions, so it is important to train, coach, and support peers. Table 4.8 includes a list of specific target
behaviors that can be taught to peers to facilitate social interactions, taking age into consideration. Key points
when teaching peers include the following:

Table 4.8. Skills to teach peers to facilitate social interactions

Younger peers Initiate, respond to, and maintain interactions
Start and engage in conversations (e.g., greet)
Give and accept compliments
Share and take turns
Help others and ask for help
Older peers In addition to the skills listed above:
Provide positive feedback
Model contextually relevant communication skills
Assist with transitions
Share materials
Reinforce communication

• Teach peers about the unique qualities of autism so they can recognize and appreciate individual
differences.
• Encourage peers to use verbal and nonverbal cues to gain the child’s attention.
• Encourage peers to wait for the child’s response.
• Support peers in trying to interpret the child’s behavioral responses.
• Encourage peers to respond to the child’s initiatives.
• Provide peers with reminders of what to do and say to help the child with autism succeed.
When peers are given direct support and guidance in select activities, it can have a positive effect in other
activities and facilitate generalization of social skills in children with autism (AFIRM Team, 2015). Peer
supports can increase spontaneous use of acquired social skills in different activities and with different peers
who were not involved in the peer training or social skills intervention. The natural reinforcement that occurs
from the social interaction between the child with autism and the peer can also reduce the need for adult
support.

Consider the Influence of Core Skills on Social Play and Leisure Skills Successful participation in social play
and leisure is also influenced by the child’s core skill abilities. In the context of each play and leisure activity,
examine the following abilities:
• Shared attention: The child’s ability to observe peers
• Imitation: The child’s ability to imitate peers
• Organization: The child’s level of organized, purposeful activity when alone versus when in a group

Other Considerations When Planning Social Play and Leisure Intervention

1. When teaching children what to DO during social play, consider the following:
• Ensure that the child can demonstrate meaningful solitary play and engagement with the objects and
materials, selecting activities based on his or her level of familiarity and interests.

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 • Plan for all of the various dimensions of the social activity.
• Focus on social skills and activities that are mutually enjoyed by the child and peers.
• Enhance social success by selecting activities that the child has mastered with adults.
2. When teaching children with autism how to WATCH others during social play, consider the following:
• Support the child in sharing physical space with others. Initially, provide the child with his or her own
set of materials in close proximity to peers.
• Support the child in sharing materials with others. Structure parallel play and leisure activities to
ensure understanding of what specific objects and materials are to be shared with peers.
• Teach turn-taking skills only in activities in which the child demonstrates core skills.
• Use structured, closed-ended activities before introducing open-ended activities.
3. When teaching the child how to LISTEN, consider the following:
• Teach, coach, and support peer partners as much as the child with autism.
• Focus on the child’s responsiveness to peers before encouraging social initiations.
• Teach the child to respond nonverbally and acknowledge peers.
4. Finally, when teaching the child what to SAY, consider the following:
• Teach the child how to respond to peers’ conversational overtures.
• Teach prosocial communicative behaviors such as giving compliments.
The following vignettes illustrate social play and leisure intervention plans for children with autism who
have different skills and abilities.

Andy possesses a limited capacity to participate in open-ended or unstructured social play and leisure activities. He only
watches his peers intermittently in highly structured activities and never imitates them. His social intervention plan
consists of a progression of activities to promote peer observation, sharing, and turn taking (WATCH) and includes 1)
partner interactions requiring no waiting (e.g., carrying items together), 2) partner interactions requiring sharing but
no turn taking (e.g., coloring with shared markers), 3) partner interactions requiring simple turn taking (e.g.,
throwing and catching a ball), 4) simple group interactions involving no materials (e.g., choral singing, playing
chase), and 5) simple group interactions involving an object (e.g., listening to a story).

Brendan has a wide range of interests, solid core skills in a variety of settings, and an interest in peers. Nonetheless,
Brendan requires social predictability in order to participate in social play and leisure activities. Thus, the focus of his
social instruction is to refine his skills in structured situations by encouraging him to respond to peer initiatives
(LISTEN). Peer activities used for Brendan’s intervention include 1) structured games, 2) cooperative games, and 3)
an adult-facilitated activity with a partner once a day in a quiet room. Peer coaching is central to this plan.

Design Intervention for the Development of Group Skills

Teaching individuals with autism to learn and interact in group settings is critical for school and work success.
Similar to the intervention for teaching social play, the plan for teaching group skills also follows the “what to
DO,” “whom to WATCH,” “when to LISTEN,” and “what to SAY” framework. Intervention must take into
account the critical elements of group participation observed in typically developing children. The ability to
participate in groups depends on an understanding of group expectations (DO) and the role of each group
member (WATCH). Participation in a group requires the ability to attend and respond to relevant verbal and
nonverbal cues (LISTEN-SAY). The plan to expand the repertoire of group skills for a student with autism
must include decisions about how to design intervention and what to teach.
How to Design Intervention to Teach Group Skills Two factors to consider when determining how to
teach group skills include 1) the student’s social, cognitive, and language skills and 2) the structure of the
social group. Successful group participation includes the basic ability to attend to others in the group and
follow directions. Some group activities require waiting and taking turns. Some group activities require
reciprocal communication, whereas other group activities do not. Successful group participation depends on
the child’s core, social, cognitive, and language skills relative to the requirements of the specific group activity.
As with social play and leisure, the child’s core ability to observe others, imitate others, and remain
organized contributes significantly to success in different group activities and should be considered during

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intervention planning. The requirements of the group activity need to be evaluated in relation to the child’s
core skills. His or her ability to observe, imitate, and remain organized will vary with the group type and
environment. Children who lack social observation skills in specific types of group settings should be provided
needed individual supports to participate.
The requirements of the group activity also need to be evaluated in relation to the child’s current cognitive
and language skills. Some group activities require comprehension of language or specific communication skills
in order to participate, whereas others do not. The child’s ability to perform these skills will vary with the
group type and environment. Children who lack language and communication skills in specific types of group
settings should be provided needed individual supports to participate. The following vignettes illustrate the
differences in group skills in children with autism.

Hadeel participates in activities that require no language, but she does not attend during language-based group
activities.

Chen follows routine verbal directions but not novel directions during group activities because of limited language
comprehension.

Rho follows only specific verbal directions due to an inability to use social cues to follow the lead of the group.

Corey may not follow verbal directions in group situations because he does not understand the meaning of the group
directive, “Children, do ______ (activity).”

Gonzalez responds to directions prefaced by his name and does not understand that the word everybody includes him.

Types of Group Activities Successful group participation depends on the ability to understand the group
expectations, structure, and dynamics. For children with autism, the level of structure and social predictability,
social and language expectations, and group dynamics all influence their success in group activities (see Figure
4.11).

Figure 4.11. Influences on group participation.

The predictability of the group activity, regardless of size, can vary. Expectations and roles in a group
activity become clearer when the activity is organized and structured. The activity is most predictable and the
group dynamics are clearest when everyone is expected to do the same thing at the same time during an
activity. In contrast, when individuals are doing different things (even with the same objects or materials), less
clarity exists regarding what is to be done.
Some group situations require waiting and others do not. No waiting is necessary during activities that
occur in unison, such as working on an art project or academic task next to others. Some group activities
require waiting for an unknown amount of time, such as group discussion. Other activities require waiting for
a specific amount of time, such as sequential turn taking while playing a structured board game. Any group
activity that necessitates waiting also requires that the individual must observe the social behaviors of others
and share space and materials. Furthermore, the language requirements of group activities vary. Some group
activities require comprehension of language in order to participate, whereas others do not. Considering these
factors, it is possible to categorize group activities into six different types, from easiest to most difficult (see
Table 4.9):

Table 4.9. Types of group activities, from easiest to most complex

Group type Characteristics Examples
Unison Everyone doing the same thing at the same time Movement activities: Doing aerobics

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 Minimal to no waiting Music: Dancing
Sharing and turn taking not required Art: Drawing in which everyone has own set of materials
No language comprehension or communication required Play or leisure: Everyone has own set of toys or objects
Choral Everyone doing the same thing at the same time Storytime: Listening to and/or choral reading of a book
Language understanding and use is required Music time: Listening to and/or choral singing
Minimal to no waiting Circle/meeting times: Reciting, reading from a chart, choral
Sharing and turn taking are required responses
Communication not required
Structured nonverbal turn taking Social predictability Cafeteria: waiting in line for lunch
No language required Social games: playing catch, hopscotch
Waiting required Classroom: passing out or collecting work and/or materials
Predictable turn taking Play or leisure: Playing that requires sharing toys and
Communication not required materials
Structured verbal turn taking Social predictability Structured indoor games: Playing board games
Language required Cooperative learning groups: Taking turns and sharing
Waiting required ideas
Predictable turn taking Adult-directed group activity: Individuals share verbal
Communication required information in a predictable order
Unstructured play No social predictability Recess or free play or leisure activities
Language may or may not be required Cooperative play
Waiting usually necessary
Sharing and turn taking usually required
Communication may be required
Discussion No social predictability Conversation
Language required Group discussion
Waiting required
Sharing and turn taking required
Communication required

1. Unison
2. Choral
3. Structured nonverbal turn taking
4. Structured verbal turn taking
5. Unstructured play
6. Discussion
Organize group activities based on the student’s target goals and objectives in order to make the activity as
structured and predictable as possible to support skill acquisition. The type of group activity (as described in
Table 4.9) can be used as the primary criterion for determining the level of supports needed to enhance social
participation. As with social play and leisure, the level of social predictability, activity expectations (i.e., what
to do), and language expectations (i.e., language complexity) contribute to the child’s ability to attend, wait,
take turns, and follow directions in a group. For example, if the learning objective for a particular student is
group attending, it is easier for him to attend when the group activity format is unison or choral rather than
unstructured play or discussion. If the learning objective is turn taking, the child will have less difficulty taking
turns during a group activity that is highly structured with predictable turn-taking opportunities.
Consider current skills (e.g., what the child can DO, understand, and SAY) and begin with activities that
require the student to use these existing skills in a group in order to participate successfully and build self-
confidence in a group setting. With this framework in mind, it will be easier to target goals and objectives to
increase and expand: 1) attending, 2) waiting, 3) taking turns, and 4) following directions in various group
settings. Begin with easier group types (e.g., unison/choral) and later introduce more complex groups (e.g.,
turn taking) to help the child increase and expand his or her core, social, language, and communication skills.
For most children with autism, open-ended discussion groups and unstructured play and leisure activities will
pose the greatest challenges and will require the maximum amount of instructional support. The following
vignette highlights a team’s focus on group skills for a student.

Ben’s social intervention plan is focused on expanding activities with peers at school and in the community. He has a
number of personal interests, but previous efforts to teach social skills with peers often resulted in awkward
conversations. Ben’s general goals were to 1) participate in a variety of social play and leisure activities that require
parallel participation and 2) participate in a variety of structured turn-taking group activities. The intervention plan
identified five activities at school that involved nonverbal cooperation and four activities in the community that
strengthened Ben’s peer relationships. At school, Ben and his friends engaged in several parallel activities. They 1)
distributed technology for English class; 2) practiced basketball drills at recess; 3) read books to younger children; 4)
participated in school chorus, and 5) performed assigned tasks in Science lab group. In the community. Ben 1) swam on
a swimming team, 2) joined Boy Scouts, 3) sang in church choir, and 4) did community service reading at a local
assisted-living residence. A task analysis was completed for each of the activities to identify the specific skills that Ben
needed to learn.

FRAMEWORK FOR INTERVENTION: COMMUNICATION

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SKILLS
Teaching children with autism social communication can be complex, because these are dynamic and
constantly changing skills. Typically, communication is motivated by the social experience. Social
communication, however, is unpredictable, is unstructured, and requires the integration of multiple
contextual, language, and socioemotional cues. An individual needs to formulate responses and messages
while simultaneously engaging in activities, watching, listening, sharing attention, and understanding others’
socioemotional perspectives, all of which may be difficult for a person with autism but are necessary for social–
communicative interactions. These challenges must be considered when designing communication
intervention for children with autism. The plan to expand a child’s communication repertoire must include
decisions about how to design intervention to teach communication skills and what skills to teach.

How to Design Intervention to Teach Communication Skills

It is essential to separate speech, language, and communication abilities when targeting skills for intervention.
Speech and language can exist in the absence of communication. This phenomenon is common in individuals
with autism, whose words may not be directed to others or may be used as a means of self-regulation. This use
of words differs from communication, which is inherently social. Communication involves the use of either
conventional or unconventional means to interact with others. For example, screaming to make a request or
hitting someone to protest are clear (although generally unconventional) forms of communication. Eye gaze,
facial expression, and gestures are conventional forms of nonverbal communication that occur with or without
language. Speech, sign language, and written language are conventional forms of verbal communication. Use
an assessment to examine the wide range of functional social communication skills when targeting goals and
objectives for a child with autism. Intervention to build functional communication skills includes increasing
the individual’s
• Motivation to communicate
• Means to communicate
• Variety of social functions to communicate
• Interactive role in communication (both initiator and responder)
• Engagement in basic conversation elements
These features of communication provide a framework for designing intervention, as summarized in Table
4.10.

Table 4.10. Key features of communication

Motivation to communicate Personal interests
Social interests
Means of communication Gestures
Speech and language
Augmentative and alternative system
Social functions of communication Requests for needs
Requests for information
Comments
Uses prosocial statements
Expresses feelings
Basic roles Initiates
Responds
Elements of conversation Initiates
Maintains
Repairs
Terminates

Increase Motivation to Communicate The degree of social motivation varies among individuals with
autism. Individuals with autism may
• Rarely interact socially
• Lack basic nonverbal communicative behaviors
• Demonstrate a desire to interact with others but do so in atypical ways
• Be motivated to communicate in order to have their own needs met but not to communicate socially about
shared experiences
• Not understand that social interactions are meaningful and serve multiple purposes
When social motivation is present, it is easier to build and expand social–communicative skills. Many
children with autism are perceived as having less motivation to communicate when they actually may not

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understand the purpose of social interactions. Children with autism may be motivated to communicate, but
adults and peers ignore their idiosyncratic efforts or misperceive their behaviors as noncommunicative.
A general communication goal should be to increase and expand the child’s motivation to communicate,
as measured by acquisition, mastery, and generalization of specific communication objectives that are derived
from assessment (e.g., ASCS-2). Because many children with autism display less motivation to communicate,
efforts to increase motivation must involve natural contexts and systematic arrangement of the physical and
social environments. Incorporate the following key components during all interactions in order to increase
social motivation:
• See every moment as a potential opportunity to structure communicative interactions.
• Use the child’s interests as opportunities for communicative interactions.
• Identify people who have successful interactions with the child and use their interactive strategies.
• Arrange desired objects in the physical environment to increase the child’s need to communicate.
• Embed preferred objects and activities within less-preferred situations to motivate and reinforce
interactions.
• Reinforce all attempts to communicate, then shape into more conventional means of communication.
• Make sure that the naturally occurring activity or interaction is pleasurable.
To design an intervention plan to increase motivation to communicate, examine the results from
assessments. Specifically, identify motivators that can affect learning, including preferred social and
communication partners, activities, interests, reinforcement, and emotional regulation strategies. Thus,
preferred foods, objects, and activities can be structured into communication opportunities. Knowledge about
the child’s exploratory style can also be used to select new play and leisure items and activities (e.g., a child
who seeks movement may enjoy wagon rides and learn to request more); in turn, all activities can be organized
to provide communication opportunities. Furthermore, social preferences (e.g., favorite people and social
games) provide information about the type of interaction that motivates communication. The following
vignette illustrates this point.

Aaron’s interests guide the direction of his social interaction. His list of interests includes actions such as swinging,
jumping, tickling, and hugging as well as objects and materials such as cars, puzzles, sand, and water. Knowledge of
Aaron’s likes and dislikes has helped the team hasten the beginnings of early communication. Each interest is made into
an interactive game with numerous opportunities to request the object, the activity, or the action or to comment on the
toys and the actions (e.g., “zoom, zoom” when moving a toy car). The activities are structured so that multiple
communication exchanges occur.

Select a Means of Communication Success in communication requires use of both effective verbal and
nonverbal conventional means of communication. Table 4.11 lists the range of nonverbal and verbal means of
communication. Children with autism first need to build communication by learning to use nonverbal means
such as gestures. Many children with autism who have verbal speech need to learn to combine verbal with
nonverbal communicative behaviors. Some children who do not have verbal speech need access to an AAC
system, whereas still others need to learn to combine their AAC system with nonverbal communicative
behaviors. The ultimate goal is communicative competence.

Table 4.11. Communicative means

Nonverbal means Verbal means
Physical proximity Concrete representation
Eye gaze Photographs
Moving person’s hand/face Pictographs (picture symbol)
Reaching Sign language
Pushing/pulling person Written words
Giving objects Voice output communication aid (VOCA)
Moving object toward/away Speech-generating devices (SGDs)
Contact point Computer
Open-palm request Technology-aided device
Distal point Speech
Wave
Head shake/nod
Smile/frown/other show of emotion
Other gestures

The selection of a means of communication is a critical step in the intervention process. It is essential for
the child with autism to have a conventional means to communicate. In addition, the individual should have
both a nonverbal and a verbal means of communication that can be used easily and effectively to meet his or
her needs in all settings and situations and contribute to functional communication and social–communicative

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competence. Select goals and objectives focused on nonverbal social interaction to target nonverbal means of
communication. Although speech is always the ultimate goal, an alternative means of communication should
be considered for anyone who is struggling with social–communicative interaction. If an individual with
autism does not have a verbal means to communicate effectively, assistive technology (AT) should be
considered to
• Supplement speech for the child who has little to no verbal speech
• Augment speech for the child who sometimes has trouble retrieving words
• Replace unconventional speech for the child who displays challenging behaviors that function to
communicate needs and feelings
AT is any item, piece of equipment, or system used to increase, maintain, or improve functional
communication capabilities (Assistive Technology Act Amendments, 2004). An AAC system is a form of AT
that improves an individual’s ability to communicate effectively. AAC can be used with individuals who
possess verbal speech and those who cannot currently speak. AAC involves unaided and aided means:
• Unaided refers to any means of communication that uses one’s body, such as gestures, vocalizations, and
sign language.
• Aided refers to systems that require supplemental materials (i.e., beyond the body) to communicate and
ranges from paper and pencil to communication boards to devices that produce voice and/or written
output.
Technology-aided electronic communication aids allow the user to use pictures, symbols, letters, words,
and/or phrases to create messages. A speech-generating device (SGD) or voice output communication aid
(VOCA) is an electronic AAC system with speech that may be a digitized recorded human voice or a
synthesized computer-generated voice (Franzone & Collet-Klingenberg, 2008).
When considering AAC options for communication systems, consider the advantages and disadvantages
based on the features. The features of sign language and low- and high-tech AAC are discussed next and
summarized in Table 4.12. With sign language, the focus of the interaction is on a fluid face-to-face visual
exchange with a communicative partner. Because a low-tech system may require an exchange of a tangible
visual object or picture, the conversational pace may be slow. Interaction also may be slow using a high-tech
system, which requires a focus on the technology and having individuals locate what they want to say visually
on their device. With both low- and high-tech devices, the systems have to be portable to travel, and
individuals must have necessary motor skills.

Table 4.12. Features of communication systems

Sign language Sign language is a formal language system with a complete grammar. Like speech, sign language is a temporal system. It requires face-to-face interaction and
attention to fluid social interaction. Attention to others’ signed messages requires rapid and immediate processing of the symbols. An individual must be able to
retrieve the symbol from memory without any external cues. In addition, motor planning skills, motor imitation skills, and fine-motor abilities are necessary for sign
language. Even if all of these skills are present, it is important to remember that the individual’s signed messages will be understood by only limited partners.
Low-tech Low-tech augmentative and alternative communication (AAC) system examples include the Picture Exchange Communication System (PECS; Frost & Bondy,
1994) and communication boards. These types of systems place fewer social demands on the communicator. The communication is a simple, concrete exchange that
is slow paced. Low-tech systems typically use photographs, pictographs, or printed words. This allows the individual to focus on a symbol for as long as necessary in
order to understand the meaning. The symbols do not require recall memory; rather, they serve as reminders of what to say. Low-tech systems have minimal
requirements. Their messages are generally understood by everyone; however, low-tech systems may limit the number of communication messages that an individual
can generate.
High-tech High-tech AAC system examples include voice output systems utilizing technology. Speech output communication systems can be programmed for individuals
using pictures, pictographs, or printed words. One of the advantages of many high-tech systems is that the individual can generate a broader repertoire of messages.
Some systems use written language, giving the individual access to a formal language. The advantage of speech output systems is that they give the individual a
“voice” and can make the power of communication more salient. High-tech systems, like computers and other technology, can be intrinsically motivating. Some
disadvantages of high-tech systems are that they are sometimes fragile, less portable, and more costly and can have the same problems as any other technological
device.

Multiple variables, particularly family preferences, contribute to the selection of a communication system.
The appropriate selection of one or more communication tools can enhance the child’s abilities to build
competency. Similarly, a mismatch between the individual’s needs and the selected communication system can
inhibit both social motivation and functional communication.
SETT by Joy Zabala (2005) is a structured framework to help gather and organize information that guides
decisions about the selection of a communication device. SETT is an acronym for four elements:
• S = Student (i.e., Who is the individual?)
• E = Environments (i.e., Where is the individual when he or she needs to communicate?)
• T = Tasks (i.e., What communication is required for the individual to be an active participant in the
environment?)
• T = Tools (i.e., What communication system or device is person centered, environmentally friendly, and

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 task focused?)
Using a structured framework like SETT can guide selection of a communication tool that will best meet
the needs of a child with autism and help address and overcome many of the obstacles that lead to
abandonment or underimplementation of communication systems. Table 4.13 provides questions that can
help guide selection of a communication system.

Table 4.13. Questions to guide selection of a communication system

Element Questions
Individual’s communication characteristics What are the individual’s interests and preferences?
What is the individual’s cognitive level?
What are the individual’s current speech and language abilities?
What is the individual’s repertoire of nonverbal and verbal communicative behaviors?
What are the functional communication concerns for the individual?
What is the individual’s level of motivation to communicate?
What is the individual’s current means to communicate?
What are the expectations for the individual related to communication?
What does the individual need to be able to communicate that is difficult or impossible to do independently at this time?
Does the individual have any challenging behaviors that need to be considered in the selection of the communication system?
Environmental demands What is the arrangement of the settings that the individual needs to communicate in?
What support is available to both the individual and any adults who help the individual?
Are there any obstacles to accessing communication in the settings?
Communication demands What are the specific communication demands in the settings?
What specific communication messages are required for active involvement in the settings?

After selection, determine whether the system is going to be a good fit for the person with autism. Here
are two ways to determine fit:
• Select one communication system and monitor whether the system supports the acquisition, mastery, and
generalization of target communication skills across multiple environments and social partners.
• Systematically teach multiple communication objectives using different systems in order to assess the best
system for the individual. For example, target three words using a low-tech system and three other words
using a high-tech system. Then, compare the rate of acquisition, mastery, and generalization using each
system.
Ongoing assessment of the communication system is needed to revise, update, modify, adapt, or replace
systems as skills and abilities change. The following vignettes illustrate the importance of providing an
appropriate means of communication, including examples of how to teach communication skills and increase
motivation to communicate using AAC.

Jared is a triplet who has no oral speech. The school had tried a low-tech PECS with him, but he was not motivated to
use the system. After an assessment, the team decided to use a high-tech system that used technology, because Jared was
very motivated by technology. He was sitting at his dining room table with his siblings when his mother asked them if
they would like more animal crackers. His mother was working on teaching him to use his VOCA. She modeled asking
for another animal cracker on the screen on the device and then passed the device to his sister. His sister, instead of
asking for more, pushed a button that said poop. The triplets laughed while their mother frowned at her. Their mother
handed the device to Jared and asked him if he would like more animal crackers. He repeatedly pushed the symbol for
fart, and the triplets howled in delight. The communication system allowed Jared to express his sense of humor.

Albert rarely spontaneously communicates using his AAC device. He doesn’t “talk” unless he is prompted to do so
(student abilities). Each student in his class has job responsibilities. One of Albert’s preferred jobs is getting ready for
snack. He sets the table with napkins and cups. His team decided to limit the accessibility of the necessary supplies by
putting them in the locked cabinet or on a high shelf (environment). Now, Albert has to ask for the napkins and other
necessary materials for snack. Sometimes he is handed an almost empty container or an inappropriate utensil for the
snack (forks for pudding). Albert is now using his device more, spontaneously requesting the necessary supplies, making
occasional comments about snack, and starting to become more spontaneous in other activities and environments.

Expand Communicative Functions Helping individuals with autism achieve success in communication
requires an understanding that interactions occur for a variety of functions and social purposes. The social
functions of communication include responses to others and initiations that convey various requests, ideas,
and feelings. Before the emergence of language, effective communicators use nonverbal means to express a
range of communicative functions. Once language is present, typically developing children combine nonverbal
and verbal means to express the full range of communicative functions. Children with autism show significant
differences in their functional use of nonverbal and verbal means of communication. They may demonstrate a
more limited repertoire of communicative functions and/or they may demonstrate more unconventional
social–communicative behaviors.
Children with autism may not use communication for a large variety of functions. Both preverbal and

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verbal children with autism typically make requests and refuse; however, they are more limited in their ability
to comment on shared experiences, express feelings, or use prosocial statements (Wetherby et al., 2014).
Unconventional social communication includes the use of challenging behaviors that serve social and
communication functions and the use of noninteractive language behaviors. For instance, challenging behavior
serves a communicative function in the child who screams to make a request. Noninteractive language use is
demonstrated when a child engages in self-stimulatory or self-regulatory speech without any apparent social
purpose. As a further example, echolalia, an unconventional communication style common in many verbal
individuals with autism, can be used for both social and noninteractive purposes (Rydell & Prizant, 1995;
Stiegler, 2015).
Because of the varied and sometimes atypical purposes of the communicative behaviors seen in autism, it
can be difficult to evaluate an individual’s social intent and the communicative function. For example, a child
who says “Put it away?” may be requesting to finish an activity, whereas others may perceive the
communicative function to be asking a question. Similarly, a child who says “Time to go home?” may be
asking to leave a stressful situation, whereas others may perceive the message as a request for information. The
function of the child’s speech can be determined by considering the context and observing the nonverbal
actions that occur prior to, during, and after the message. Observing how and to what extent the child directs
the message to others, waits for a response, and persists with the communication attempts also assists in
evaluating communicative function.
The central focus of communication intervention is to target goals and objectives to increase and expand
the use of communication for a variety of functions and social purposes. These different functions fall into
general categories. These skill categories, which do not represent a developmental social–communicative
hierarchy or a linear progression of target skills, are as follows:
• Requests for personal needs
• Responses to others
• Comments
• Requests for information
• Expressions of feelings
• Prosocial statements
Plan intervention to foster successful communication and to require the child to use conventional
nonverbal or verbal means for a variety of social purposes, with multiple partners, and across a variety of
contexts. Intervention must emphasize the individual’s functional skills within social–communicative
interactions. The intervention plan should help the child with autism communicate
• A range of communicative functions
• Age-appropriate messages
• Across multiple social partners (e.g., adults, peers)
• Across multiple contexts
Expand Functions It is important for children with autism to be able to convey a multitude of
communication functions. The goal to expand functional communication should supersede attempts to
expand language. For example, if a child’s repertoire of functional communication is limited to single-word
requests for food and objects, the intervention goal might be to build additional functions into that child’s
communication repertoire, such as labeling or asking someone to play. Efforts to expand the child’s language
from a single-word request (e.g., “cookie”) to an elaborate request (e.g., “I want cookie, please”) should be
secondary.
Mirror Same-Age Peers and Use Age-Appropriate Messages It is important to select messages that mirror
the communication of same-age peers. Carefully examine the interactions of typically developing peers and
identify the essential elements of social acceptability. For example, most typically developing peers ask a friend
to play by gesturing or saying “Come here.” Teaching a child with autism to say, “(peer’s name), I want to play
(name of activity)” may be more difficult for the individual and may also add to his or her social difference.
Most young children are likely to say “Again” or “Do it again” to get another push on the swing. Teaching
children with autism to request this action by saying “Push more, please” can stigmatize them.
Consider Social Partners It is important to consider the social partners when planning communication

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skills intervention. As with social skills, it is common for young children with autism to master
communication skills with adult partners before generalizing them to peer partners. Again, this distinction is
largely due to the adult social partner’s ability to understand the communication efforts of the child with
autism and to adapt the interaction to enhance success. Planning for communication success with peers begins
with selecting interactions in which the child has demonstrated mastery with adults.
Target Multiple Settings It is important to target words and messages that can be used in multiple
settings. Generalized terms (e.g., do, go, this, that, it, here, there) can be taught contextually and used in a
variety of settings for a variety of functions. Phrases such as “Do this,” “Go there,” and “Want that” help
expand communication without the need for expanded language.
Figure 4.12 demonstrates two different ways to design communication intervention in terms of expanding
functional communication. In Plan I, first target a specific communicative function and then select social
environments in which the individual can have multiple opportunities to practice the message. In Plan II, first
target a specific social setting and then select the communicative function(s) the individual will practice. The
first approach provides for more systematic instruction and an easier means of assessing skill mastery. The
second approach provides more program flexibility and more opportunities to build multiple communication
skills simultaneously and increases functional generalization.

Figure 4.12. Options for designing intervention to expand functional communication.

In summary, to expand communication for a wide variety of social functions

• Target specific communicative functions and systematically teach and practice them across multiple social
contexts and social partners.
• Target specific social contexts and social partners when practicing communication skills.
• Use every opportunity to teach generalization and functional application of skills in a systematic fashion.
The following vignette illustrates how to expand functional communication.

Derek was taught to ask a novel question. Before then, he did not understand that other people could be a source of
information. He would ask the same questions repeatedly in order to get predictable answers, but he had never
generated a novel question. Therefore, the target function was asking a question. The target settings included multiple
natural or contrived contexts. Using a cue card with a picture for the target message, he was taught to ask, “What is
it?” during a lotto game, during show and tell, when given an object, when looking at novel pictures, and in many
other situations. In the initial context, the adult working with him needed to pair the graphic cue with a verbal model,
but she quickly faded the verbal prompt. Derek used the cue card in novel situations until he gradually learned the
meaning of the question; that is, “When I see something new and want to know the name, ask the question!” Through
intervention, Derek acquired a means to communicate his own curiosity.

Teach Basic Communicative Roles Communication is a reciprocal social exchange—an effective

communicator both initiates interactions and responds to the initiations of others. Successful intervention
must support the child with autism in assuming both roles. Many children with autism only learn how to
respond to questions (e.g., “What do you want?” “What is it?”) and lack the ability to initiate communication.
Others only initiate to have their basic needs met and lack the ability to talk socially about shared experiences.
Others with autism are lacking the social functions of sharing feelings and expressing prosocial statements.
Spontaneous initiations require an ability to extract relevant information from a social context in order to
decide what to say. An infinite number of potential messages can be conveyed in any situation, so the decision
about what to say is determined by making a mental assessment of internal and external factors. One’s

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thoughts, feelings, ideas, and perceptions of the physical and social environments are considered. Individuals
with autism often experience more difficulty with spontaneous initiations. They are more likely to use
communication that is prompted by concrete cues and that has a clear and immediate effect on the
environment, and their use of requests or refusals is linked to tangible contextual cues and consequences. In
addition, many forms of echolalia are cued by explicit physical or social events. Difficulty initiating
communication may be linked to the absence of explicit physical and/or social cues. Children with autism may
have difficulty generating novel information without contextual cues. The degree to which the child can
extract relevant cues in natural contexts influences the degree of spontaneous communication.
Use an assessment (e.g., ASCS-2; see Chapter 3 Appendix) to determine the child’s ability to perform the
basic roles of responding to and initiating interaction with others. Target goals and objectives to build
communication skills and conversational skills so that the child both initiates interactions and responds within
social–communicative interactions. Plan intervention to foster reciprocal exchanges, which provides
opportunities for the child to
• Expand meaningful responses within social–communicative interactions
• Expand spontaneous initiations within social–communicative interactions

Expand Meaningful Responses There is a significant difference between teaching a child with autism a
repertoire of responses and teaching the individual meaningful social–communicative interaction.
Communicative messages that are not taught within the context of functional use risk becoming a series of
patterned responses devoid of meaning. It is important to set up opportunities that allow the child to
meaningfully respond in a reciprocal social–communicative exchange. Keep in mind that motivating and
meaningful interactions are the inherent reinforcing “M&Ms” of intervention. The following vignette
illustrates a patterned response.

Devon had been taught to answer the question, “How are you?” with the response, “I’m fine, thank you.” One day, he
looked sick. His teacher asked, “How are you?” He replied, “I’m fine, thank you” and then proceeded to become violently
ill. This social exchange created a meaningless response on his part.

Expand Spontaneous Initiations It is important to expand the child’s use of spontaneous initiations to
foster reciprocal social–communicative exchanges and functional communication. Intervention should include
plans to
• Expand communication in the absence of verbal cues and prompts
• Expand communication in the absence of social cues and prompts
Facilitate spontaneous initiations by changing adult–student interaction patterns, particularly by shifting
interaction away from a directive style of asking questions to a facilitative style of commenting. Explicit verbal
cues, specifically questions and directives, limit opportunities for spontaneous communication. Facilitate
spontaneous initiations by quickly fading the use of verbal cues and increasing the use of explicit physical and
visual cues. For example, organize the physical environment to stimulate interest and spontaneous
commenting instead of simply asking, “What is it?” In addition, spontaneous initiations can be expanded by
increasing the use of visual supports. For example, a wallet containing photos of favorite activities or a
communication board may assist a child in making choices about what to say and can foster his or her
spontaneous communication with peers. The following vignette illustrates an example of how to expand
initiations.

Rachel attended an inclusive school. She silently sat with three peers during art class each day. Efforts to prompt
comments about the activity were too vague for her, and she inconsistently imitated adults and peers. Two
modifications were made to the setting to increase her spontaneous comments. One was that at the end of the activity,
each student displayed his or her artwork and the other students took turns saying one nice thing about it. The second
change was that a communication board was made for her that included four different things she might say about her
friends’ artwork: “It’s nice,” “I like it,” “Pretty,” or “It’s ________ (followed by a list of colors)”. She gradually
decreased her reliance on the communication board and increased her imitation of her peers’ comments.

Teach Basic Conversation Skills Teaching conversation skills integrates all the essential features of
communication that have been discussed thus far. That is, to take part in a conversation, a person must have
motivation to communicate, a means to communicate, and an understanding of both communicative functions
and basic communicative roles. Conversation is a complex cognitive process that requires the ability to

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• Attend to the speaker
• Attend to multiple aspects of the speaker’s message
• Process multiple aspects of the speaker’s message
• Interpret the intent and meaning of the speaker’s nonverbal, verbal, and affective behaviors
• Understand the speaker’s message in relation to the social context
• Understand the speaker’s mental state (i.e., what partner knows, understands, and feels)
• Monitor relevance of the conversation for the other person
• Take turns speaking and listening during a conversation
• Engage in a variety of communication topics, topic shifts, and topic maintenance
• Organize ideas relevant to topic of conversation
• Retrieve information relevant to topic, partner, and context
• Use appropriate proximity, affect, and body language
• Continually adapt to ongoing, changing social dynamics
• Be aware of different communication styles with different partners
Assess the child to identify the presence or absence of basic conversational skills, and target goals and
objectives to increase basic conversation skills. The minimal requirements for a conversation are the ability to
1) initiate a conversation, 2) maintain reciprocal interactions, 3) repair a conversation, and 4) terminate a
conversation.
To design intervention for increasing basic conversational skills, identify the conversational abilities and
interests of same-age peers to target topics of conversation and specific messages to teach. Intervention to
build conversation skills should begin by using routine messages. Examples include
• Initiation (nonverbal): proximity to partner, tap partner’s arm, show an object
• Initiation (verbal): say a peer’s name, “Hi,” or “Know what?”
• Repair (verbal): say “What?” or “I don’t know”
• Termination (nonverbal): wave, put away conversation referent
• Termination (verbal): say “Bye,” “Gotta go,” or “See you later”
The complex, ongoing adjustments and modifications inherent in conversations challenge even those
individuals with autism who are socially motivated and possess intact language abilities. As a result, their
conversations often involve routine scripts, situation-specific topics, or predictable question–answer exchanges.
Teaching individuals with autism to become attuned to the multiple dimensions of social–communicative
interaction can be challenging. To begin to build and expand on basic conversational exchanges, incorporate
the following:
• Structure conversations around a familiar activity or interest with familiar dialogue and then expand the
dialogue to similar, novel activities.
• Practice conversation rules within the context of familiar games and activities and then generalize skills to
novel activities.
• Teach expanded social scripts, conversation starters, age-appropriate topics, repair strategies, a variety of
questions, and how to end a conversation one message at a time, one setting at a time.
• Structure opportunities that allow preview, review, and practice of conversation skills through the use of
visual supports such as social narratives, social scripts, and video modeling.
Children with autism generally learn conversation skills by practicing with adults. In these situations, the
responsibility largely lies with the adult to adjust his or her interaction patterns to accommodate the child.
However, this is not how conversations occur in the real world. As a child masters isolated conversational
skills, support conversations in natural settings with peers to ensure generalization of the skills. The following
vignettes demonstrate ways to enhance conversational abilities.

Sean approached people in the community every day and said, “What color is your car?” He needed some explicit cues to

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remind him of what else he could say to community members, so each weekend his family organized a wallet containing
photos of his recent activities to use in school. Sean was taught to approach peers and say “Hi,” and his peers were
coached to ask to see his wallet. The photos gave both him and his peers conversation cues.

Pat has been successful with one-to-one peer interactions but is unable to converse in groups. He practices “what to
DO, whom to WATCH, whom to LISTEN to, and what to SAY” in group situations by watching videos of his peers
playing and talking in familiar situations. He and his teacher generate lists of how to get the group’s attention and
how much to say. To ensure the intervention’s success, his family practices the basic skills at home with him. In
addition, his peer group has been coached to be aware of his efforts, to acknowledge his attempts to get their attention,
and to wait for him to finish talking.

FRAMEWORK FOR INTERVENTION: COMMUNITY SKILLS

An intervention plan to teach community skills requires the integration of all the core skills, social skills, and
language and communication skills discussed previously. Teaching children with autism to participate with
family and friends in social activities in the community often is the biggest challenge, requiring the ability to
DO-WATCH-LISTEN-SAY in a flexible, fluid manner. As stated previously, children with autism benefit
from structure, predictability, and organization—elements that are typically lacking in community
environments. In the community, children are expected to participate in physical environments that are busy
and unstructured and in social settings that involve large groups with unpredictable social behaviors. Children
with autism, particularly those who exhibit sensitivities to various sensory stimuli and those who are anxious
with changing situations, may experience challenges in some community settings. The plan to expand the
repertoire of community skills must include decisions about how to design intervention and what to teach.

How to Design Intervention to Teach Community Skills

An intervention plan to teach community skills involves the following steps:
• Assess the social, communication, and behavioral needs required in the setting.
• Target prioritized skills and/or replacement behaviors for the setting.
• Develop an instructional plan to teach skills and provide supports in the setting.
Table 4.14 provides a framework for planning community skills.

Table 4.14. Framework for planning community skills intervention

Assess community setting and skills Assess the individual’s skills in the target setting (e.g., task analysis, ecological inventory). Ask questions such as
What typically occurs in the setting?
How do others interact with the individual in the setting?
Are there aspects of the setting that may be uncomfortable for the individual?
What is the individual expected to do in the setting?
What preparation needs to be given to the individual prior to the activity?
Target skills and replacement behaviors Identify intervention priorities by determining whether the individual has the necessary social and communication skills to participate in a
community activity. Target clear goals by asking questions such as
What skills observed in the setting need to be taught (using the DO-WATCH-LISTEN-SAY progression of skills)?
What skills are the most important and could be applied across multiple community settings?
What adapted skills could be taught in the setting?
Are there alternative ways to demonstrate the skill?
Is augmentative and alternative communication needed?
What relaxation and self-regulation strategies are needed?
Develop an instructional plan to teach skills and provide Develop an intervention plan to teach the identified individual community skills along with appropriate replacement behaviors.
supports Develop plan based on the identified social and behavioral needs.
Prepare and preview the community activity.
Teach target skills.
Plan how the individual will relax and/or maintain self-control in the setting.
Develop a consistent and positive plan for responding to the individual’s challenging behaviors.
Develop a plan that includes instructional supports:
Organizational supports
Social supports
Visually cued instruction
Augmentative and alternative communication supports

Assess The first step to develop an intervention plan to build community skills is to examine the setting
and conduct an assessment, such as using a social task analysis (see Figure 4.8) or a detailed community
planning guide (see Chapter 9 Appendix) to establish the skills the individual already possesses and which
skills need to be taught for success in different community settings. Begin with some critical questions that
help assess the level of preparation that needs to be given to the child with autism prior to the community
activity. In addition to obtaining basic information about the presence or absence of necessary skills for
participation in particular community activities, it is important to assess the child’s social and communication
needs. Establish what community social skills need to be taught by asking “Does the individual have the skills
within the domains of DO-WATCH-LISTEN-SAY necessary for a particular community setting?” and
answering questions such as

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• What typically occurs in the setting?
• How do others interact with the individual in the setting?
• Are there aspects of the setting that may be uncomfortable?
• What is the individual expected to do in the setting?
• What preparation needs to be given to the individual prior to the activity?
In addition, behavioral obstacles should be assessed. Identify whether the child has any challenging
behaviors in specific community settings that interfere with his or her participation. For most children with
autism, challenging behaviors are directly linked to a lack of social and communication skills.
Target Skills The next step is to identify social and communication skills for instruction. Develop a plan
based on the identified social and behavioral needs. As indicated previously, children with autism first learn
what to DO and whom to WATCH, then they learn interactive skills in the domain of LISTEN, and last
they learn what to SAY. The selection of specific skills to target depends on the child’s present social and
communication behaviors. For example, social and communication skills that the child demonstrates in other
settings could be targeted for generalization to a particular community setting. Prepare and preview the
community activity. Use the skills and behaviors of typical peers as a guide, and target realistic and necessary
skills for the child’s participation in the setting.
Plan Support The final step of the intervention plan is to identify the instructional strategies and
supports that will be used to teach skills in the community. The intervention plan should include plans on
how to teach the identified community skills along with appropriate replacement behaviors. Strategies and
supports include 1) strategies to preview and practice isolated skills before going into the community; 2)
strategies to prevent and support positive alternatives to challenging behaviors; and 3) an instructional plan
that incorporates organizational supports, social supports, and communication supports, including AAC. Plan
how the child will relax and regulate to stay calm or maintain self-control in the setting. Develop a consistent
and positive plan for responding to challenging behaviors.
To summarize, community settings require integration of all cognitive, language, social, and
communication skills, posing the greatest challenge for the child with autism and requiring the most
comprehensive intervention plan. The Chapter 9 Appendix includes blank templates and completed examples
of both a social task analysis and a community planning guide, each of which can be used for assessment and
intervention planning to meet the individual’s complex programming needs in the community. The following
vignettes provide examples of intervention plans for community outings.

Zoe was very active. Her mother found it impossible to manage Zoe during trips to the grocery store. Using an
assessment to identify Zoe’s social and behavioral needs, it was determined that Zoe 1) did not understand when the
activity would be finished, 2) became overstimulated in the dairy aisle because she liked cheese, and 3) maintained
inappropriate behavior because she was once given an ice cream bar after she began screaming in the store. The
intervention plan included 1) previewing a visual support that showed where she was going and what her mother was
buying, 2) using a timer to indicate when the activity was finished, 3) providing an ice cream bar upon arrival, and
4) giving her a backpack containing a favorite object while waiting in the cashier line. The length of time for which
Zoe behaved appropriately in the grocery store gradually increased from 2 minutes to 20 minutes.

Bret screamed uncontrollably at the doctor’s office. Using assessment to identify Bret’s social and behavioral needs, it
was determined that Bret understood what was expected of him (i.e., what to DO) but was afraid of the experience
and very sensitive to touch. Bret’s intervention plan involved 1) video modeling—having him watch a video about
going to the doctor’s office, 2) having him practice doctor visits by attending the school nurse’s office, and 3) teaching
him a self-management relaxation procedure. After employing these strategies over the course of a few months, Bret
was able to visit the doctor’s office calmly.

FRAMEWORK FOR INTERVENTION: RESTRICTED AND

REPETITIVE BEHAVIORS
Individuals with ASD tend to seek order, routines, and repetition more than do typically developing people.
The phenomenon of restricted and repetitive behavior dominates their social and communication patterns.
These behavior patterns exist for a reason. Behaviors reflect cognitive and social knowledge, communication
abilities, and emotional states. Restricted and repetitive behavior may represent a limited understanding about

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what to DO and what to SAY. These behaviors can occur in response to external events and internal states.
The intensity of the restricted and repetitive patterns may reflect the child’s level of comfort and/or
understanding at any point in time.
States of excitement, anxiety, boredom, and confusion all have the potential of triggering restricted and
repetitive behaviors. These behaviors can occur for enjoyment. Some behaviors help the individual self-
regulate, whereas other behaviors can be disruptive. Emotional outbursts can trigger the onset of intense
restricted and repetitive behaviors. Similarly, a disruption to a restricted and repetitive pattern can trigger an
emotional outburst. Restricted and repetitive patterns of behavior may also occur as a result of underlying
medical conditions. The form and intensity of restricted and repetitive behaviors can vary significantly among
children and youth with autism. These behaviors can increase in complexity and intensity over time without
intervention.

Assessment of Restricted and Repetitive Behaviors

Begin with an assessment to determine why the child with autism engages in restricted and repetitive
behaviors. Determine the meaning of the behavior for the individual (i.e., the function of the behavior). This
requires inquiry into the antecedent events and a careful observation of the child’s emotional state and other
accompanying behaviors.
First, document instances of the targeted behavior—where, when, and how often it occurs. Observe the
child to determine what happened before the behavior. Common antecedents are an uncomfortable sensory
experience, something or someone of intense interest, an unexpected change, a difficult task, a social
intrusion, or contact initiated with others. It is important to separate behaviors that are solitary in nature from
those that are atypical attempts to interact, because intervention strategies will differ accordingly.
Second, examine what else the child is doing while engaged in the restricted and repetitive behaviors.
Patterns provide insight into the reason for the behavior. They can include ignoring all other people and
events, looking at others for a reaction, persisting with the behavior until acknowledged, or engaging in
another activity while performing the restricted and repetitive behaviors. It is important to separate behaviors
that appear nonproductive from those that may be used to self-regulate or interact with others. This is
particularly relevant when assessing the function of verbal restricted and repetitive behaviors such as some
forms of delayed echolalia, perseverative questions, and ritualized conversations. For example, if the verbal
rituals are the child’s way of talking himself through a meaningful activity, then allow the individual to use the
restricted and repetitive behavior. Self-regulatory verbal restricted and repetitive behaviors typically fade away
naturally as a child masters an activity.
The third step for assessing the function of a restricted and repetitive behavior is to observe the child’s
affect while he or she is engaged in the play, leisure, or verbal behavior. Because restricted and repetitive
behaviors often are observed as a response to an emotionally arousing situation, the child’s emotional
expression can provide clues as to whether the behavior is triggered by enjoyment/excitement, discomfort, or
confusion. Other restricted and repetitive behaviors may not be an expression of emotion but a learned pattern
or an indication that the child lacks a specific skill. Finally, restricted and repetitive behaviors can be a
manifestation of a neurological disorder and can occur without clear environmental antecedents. Regardless, it
is important to first determine the function of the behavior in order to plan an appropriate intervention to
address the reason for the behavior.

Determine Underlying Causes of Behavior

Before designing a plan to change the restricted and repetitive behavior, begin with this question: Does the
intensity of the behavior warrant attention and intervention? Information about restricted and repetitive
behavior can be collected through assessment. For instance, the ASCS-2 Obstacles Questionnaire includes
sections on social, communication, and restricted and repetitive behaviors. If the team/family thinks that the
child’s restricted and repetitive behaviors are a major obstacle to social and/or communication development,
then the behaviors require intervention. If the behavior warrants attention, ask the following questions to
determine the intervention goal:
• Can the child be taught when and where to engage in the behaviors?
• Can the behaviors be shaped into replacement social skills?
• Do the behaviors require medical attention?

The options for intervention are better understood when we examine the underlying causes of restricted
and repetitive behavior in autism. There are a number of theories regarding the cause of these behaviors, and

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it is likely that multiple factors interface in complex ways that are not fully understood. It also is probable that
intervention for restricted and repetitive behaviors may need to be a combination of educational and medical
treatment to address both internal and external causes. To support children with restricted and repetitive
patterns of behavior, you may assume that the behaviors derive from multiple sources and may be a
manifestation of any of the following:
• Poor inhibition associated with a medical disorder: Behavior occurs when alone, independent of
environmental factors.
• Anxiety: Behavior increases in intensity when there are stressful situations, loss of control, and/or changes
in routines.
• Impaired sensory regulation: Behaviors are an expression of sensory sensitivities or preferences.
• Impaired social cognition: Behavior increases when the child is confused, misunderstands the social
context, has ineffective social skills (e.g., not understanding what to DO), has ineffective communication
skills (e.g., not understanding what to SAY), or struggles with cognitive processes (e.g., inability to shift
mental focus).
Poor Inhibition A medical condition such as poor inhibition can contribute to the intensity of restricted
and repetitive behaviors. If the behaviors seriously disrupt a child’s life and learning and/or are causing the
family a high level of stress, then the family should seek a consultation with a physician to rule out medical
intervention. Obsessive–compulsive disorder, anxiety disorder, and other related disorders are conditions that
can be a secondary diagnosis in individuals with ASD (Attwood, 2003). There are times when behavioral and
educational intervention is combined with medication to maximize successful outcomes.
Anxiety Internal and external issues, such as anxiety, can contribute to the intensity of restricted and
repetitive behaviors. Autism is associated with a high level of anxiety (Mazefsky & Herrington, 2014), and
restricted and repetitive behaviors can be a primary means to self-regulate. As such, restricted and repetitive
behaviors can be extremely intense when the child is anxious and/or emotionally explosive. Addressing the
cause of the anxiety may indirectly change the behaviors. Repetitive behavior and restricted routines are
frequently important and meaningful to people with autism, helping them to manage anxiety and have some
measure of control over a confusing and chaotic world.
Impaired Sensory Regulation Restricted and repetitive behaviors might be an expression of emotional
states of enjoyment or discomfort and triggered by sensory sensitivities or preferences. The presence and form
of self-stimulatory behaviors, perseverative object use, and repetitive communication patterns can be examined
in relation to an individual’s sensory preferences and sensitivities. The active individual generally seeks sensory
stimulation, whereas the passive individual generally avoids sensory stimulation (Donkers et al., 2015).
Information about the child’s fears and intense interests, as well as what best calms the child, also provides
insight into the source of restricted and repetitive behaviors. This type of information can be collected by
using assessments (e.g., ASCS-2). Discussion about a child’s restricted and repetitive patterns should include
the physical and social contexts in which there is an absence of these behaviors and the conditions under
which the child is most calm and interactive. These contexts and conditions can, in turn, be used to promote
successful intervention plans.
Impaired Social Cognition Restricted and repetitive behaviors can occur as an expression of confusion
about environmental and social issues, referred to as impaired social cognition. A functional behavioral
assessment (FBA) is recommended for any behavior that interferes with learning and development,
particularly those behaviors that are influenced by environmental and social variables. The FBA is an
assessment that closely examines variables that contribute to behaviors and can be used to identify a child’s
behavioral patterns and possible causes of a behavior. It is essential to understand the underlying reasons and
motivating factors that are maintaining the restricted and repetitive behavior patterns. An FBA can be used to
create a positive behavior intervention and support plan for the child with autism. As emphasized, the reasons
for restricted and repetitive behavior are many and varied. The behaviors can occur to escape uncomfortable or
confusing situations, or seek sensory input. They are sometimes used to comfort oneself or for enjoyment, and
they can occur as a means to communicate a need. Thus, it is important to understand the conditions under
which the behaviors are most likely to occur and when the behaviors are least likely to occur to determine
contributing environmental and social factors.

SUMMARY

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Very detailed planning is necessary to ensure that intervention matches the needs of children and youth with
autism. It is important to understand how to teach skills and what to teach when planning intervention.
Effective intervention requires specific attention to social and communication skills and an understanding of
restricted and repetitive behaviors that affect social–communicative competence in a child with autism. This
chapter provides general guidelines for designing social and communication intervention and emphasizes the
complexity of the intervention plan. The intervention frameworks presented in this chapter can be used by
parents and professionals to recognize an effective intervention and understand important considerations for
developing a comprehensive intervention plan for assessing needs, targeting goals, teaching skills, and
monitoring progress over time. The following chapter discusses many of the specific EBPs for teaching and
enhancing social and communication skills. Readers will learn about proven intervention approaches and other
best practices for students with autism, including a range of behavioral and developmental strategies.

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 CHAPTER 5

Selecting Evidence-Based Practices to Enhance

Social and Communication Skills

LEARNING GOALS:
1. Demonstrate how to select evidence-based practices to enhance social and communication skills.
• Describe the principles of behavioral, developmental, and naturalistic intervention approaches.
• Describe the current evidence-based practices that meet the social and communication needs of
children and youth with autism.
• Describe the decision-making process to select intervention practices that meet the needs of students
with autism.
• Select intervention practices to teach targeted skills, working toward generalization of functional social
and communication skills.

B uilding social and communication skills in students with autism is an involved process that requires
careful decision making and collaborative input from the educational team. This chapter focuses on
helping professionals and families make intervention decisions and select evidence-based practices
(EBPs) to build social and communication skills. The specific interventions that are supported by research, to
date, are grouped as
• Established EBPs
• Emerging promising practices
Established EBPs are simply defined as practices that produce positive outcomes and are informed by
credible research (Cook, Tankersley, Cook, & Landrum, 2008). Emerging practices do not yet have support
from a rigorous scientific base but show promise as interventions that contribute to positive outcomes.
Educators are required to use EBPs with their students.
There are a variety of evidence-based best practices essential to social and communication growth. The
various intervention approaches discussed in this chapter are classified into three general categories:
• Behavioral intervention = using principles of applied behavior analysis (ABA) in highly structured settings
(e.g., traditional methods such as discrete trial training [DTT])
• Developmental intervention = using developmental principles in natural settings (e.g., methods such as
relationship-based interventions)
• Naturalistic intervention = using a combination of ABA and developmental principles in semi-structured
and/or natural settings (e.g., contemporary methods such as Pivotal Response Training [PRT])
EBPs should be applied critically and flexibly to intervention planning. A highly prescriptive approach to
social and communication skills intervention for all children with autism minimizes the complexity and
richness of growth in developmental areas. The dynamic nature of social and communication development
requires individualizing the intervention approaches used with each child with autism. It is essential that
intervention guidelines not be used too rigidly with the diverse group of individuals that they are intended to

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help.
An understanding of the full array of intervention practices is a priority for those working to address the
dynamic needs of children and youth with autism. Because ASD represents a heterogeneous syndrome, it is
unlikely that one intervention method or instructional strategy will work equally with all. Autism affects
social, communication, and behavioral development differently for each person, so it is paramount that the
team makes individual-specific intervention decisions. It is necessary to consider the child’s level of
motivation; core skill abilities; and the degree of restricted, repetitive, and challenging behaviors when
planning social and communication skills intervention.
As discussed in earlier chapters, the intervention planning process begins by conducting assessments (e.g.,
ASCS-2) to identify the child’s specific needs and prioritizing the desired outcomes. Next, write targeted
goals with objectives based on the assessment data. This must be accomplished before selecting intervention
methods and choosing instructional strategies. Because social and communication challenges are the hallmark
of autism, the team must carefully study and evaluate the “best” means of supporting social and
communication development. Given the complexity of social and communication skills intervention, there can
be uncertainty about how to approach this daunting task. It is important to identify practices that have
evidence of effectiveness in promoting positive outcomes for students with autism, but it is also crucial to ask
and answer the question of “what works?” based on the child’s specific profile of strengths and needs. The
following section helps guide the selection of specific instructional interventions and provides information on
a variety of EBPs that can be used to build core, social, and communication skills.

EVIDENCE-BASED INTERVENTION PRACTICES

Autism is a lifelong neurodevelopmental disorder. There is no known cure for autism, but with early and
intensive intervention, some students may function at a level at which they no longer meet diagnostic criteria
or qualify for educational services. To contribute to positive outcomes, select EBPs that meet the specific
needs of the child with autism.

Selection of Practices
In evaluating intervention options, consider whether the reported outcomes associated with a specific strategy
match the needs and prioritized goals of the child with autism. Remember these important factors before
selecting interventions:
• There is no one intervention that meets the needs of all children with autism.
• An individual may require different intervention practices at different times in life.
• The team should select approaches that facilitate inclusion and functional participation in natural
environments.
• The team should select strategies that offer the greatest chance for skill acquisition, mastery, and
generalization, in the shortest amount of time, in the most natural (i.e., least restrictive) setting, and with
the least adult assistance (i.e., independent versus prompt).
When making decisions about interventions, identify the child’s specific needs, review an intervention’s
intended outcomes, and examine potential risks (see Figure 5.1). With these factors in mind, consider the
following questions to help select an effective approach for each child with autism (Simpson, 2005):

Figure 5.1. Considerations for selecting an intervention.

• What are the child’s specific needs based on assessments and prioritized goals?
• Does the proposed intervention appear meaningful (i.e., social validity) and in harmony (i.e., a match or
good fit) with the identified needs of the individual?
• Does the research demonstrate effective outcomes, and what is the quality of the evidence (e.g., empirical
evidence, efficacy, validity, reliability)?

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• Can this intervention be combined and integrated with other interventions that are currently in place?
• What are the potential risks associated with the intervention (i.e., immediate or eventual health,
behavioral, and emotional risks or impact on time and/or quality of life)?
• What is the most effective means of evaluating whether the child is making progress with the selected
intervention (i.e., how to monitor the effectiveness of the method)?
When selecting an intervention strategy, integrate scientific evidence-based research with professional or
clinical expertise and judgment, and be sure to consider the context (e.g., setting), perspectives, values,
interests, needs, and choices of the individual (ASHA, 2005).

Established Evidence-Based Practices

The term evidence-based practice describes an intervention that is generally effective for specific populations as
established by scientifically based research. The Every Student Succeeds Act (ESSA, 2015) categorizes an
intervention as having strong evidence when an experimental research study demonstrates a positive effect on
student outcomes and moderate evidence when support comes from a quasi-experimental study. The Council
for Exceptional Children (CEC) has standards for EBPs in special education that require the use of research
studies (e.g., group comparison, single subject) that are methodologically sound (CEC, 2014). Although there
is a growing body of research, current EBPs do not address all outcome areas for students with autism, nor do
they address all the diverse needs of the various age groups and ability levels on the spectrum.

Emerging Promising Practices

The term promising practices describes interventions that have at least one study suggesting they produce
favorable outcomes, but additional high-quality studies are needed to confirm their effectiveness. For example,
if the research design of the study is not rigorous (e.g., correlational design), then more proof may be required
for the intervention to be considered to have a strong evidence base (ESSA, 2015). There are also emerging
practices that have a research-based rationale. This means there is a body of evidence from research that the
strategy will likely improve student outcomes, but the body of evidence may come from outside the field of
autism. For example, an educator may find a particular intervention that is not currently considered evidence
based in the field of autism but has an established evidence base in the field of specific learning disabilities.
The intervention focuses on a challenge experienced by the student with autism, and thus the educator has a
rationale for trying the strategy. When this strategy is implemented, it may demonstrate positive outcomes for
the individual.
The CEC Interdivisional Research Group (2014) recommends that in the absence of established EBPs,
practitioners should base intervention decisions on meaningful research and select promising methods by
evaluating available evidence gleaned from existing sources. These sources might include evidence-based
reports, manuals, or guides (e.g., National Autism Center, Autism Evidence-Based Practice Review Group)
and peer-reviewed professional journals (e.g., Autism, Focus on Autism, Journal of Autism and Developmental
Disabilities, Education and Training in Autism and Developmental Disabilities).

Resources for Identifying Evidence-Based Practices

There are many resources devoted to informing professionals and families about EBPs. Widespread support
for an evidence-based approach to intervention and instruction is exemplified in the U.S. Department of
Education’s Institute of Education Sciences’ What Works Clearinghouse. This site provides educators with
information to make evidence-based decisions. Another resource is ASHA’s National Center for Evidence-
Based Practice in Communication Disorders. This site provides online evidence maps, including one focused
on autism, to guide evidence-based decision making and provide information related to assessment and
intervention. The Association for Science in Autism Treatment (ASAT; n.d.) provides a web site that
contains research summaries of an array of autism interventions. Another free resource for information online
on evidence-based and promising practices is the Autism Internet Modules (AIM; n.d.) hosted by the Ohio
Center for Autism and Low Incidence (OCALI). These modules are designed to provide high-quality
information and professional development for those who support, teach, work with, or live with someone with
autism.
Two national centers—the National Autism Center (NAC) and the National Professional Development
Center (NPDC) on Autism Spectrum Disorder—have focused specifically on autism and EBPs. Both of these
centers have used a systematic process and established criteria for evaluating studies and have organized
information into lists of intervention practices that have evidence of efficacy. Both centers have conducted

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multiple phases of research reviews to identify intervention practices as EBPs (Odom, Collet-Klingenberg,
Rodgers, & Hatton, 2010). The NAC has researched intervention models, which are a set of practices
designed to broadly impact the core challenges of autism and aid in overall learning and development. The
NPDC has researched specific intervention practices, which are designed to address a focused skill. Some
EBPs are embedded within comprehensive intervention models.
National Autism Center The NAC is a nonprofit organization that disseminates information about
autism interventions and promotes EBPs. The NAC has conducted several phases of extensive literature
reviews to determine which interventions produce favorable outcomes for students on the autism spectrum
through the National Standards Project (NSP, 2009; NSP2, 2015). The NSP report classifies educational and
behavioral interventions into three categories based on the amount of evidence. These categories include 1)
established (i.e., sufficient evidence), 2) emerging (i.e., one or more studies), and 3) unestablished (i.e., little or
no evidence). The NSP report contains basic facts on each intervention practice, including the age group for
which the practice is effective and the skills and behaviors targeted for improvement or change. The NSP
report, as well as other free resources, is available on the NAC web site. Table 5.1 includes some of the
interventions identified by the NAC-NSP (2015) at the established and emerging levels of evidence that can
be used to teach core, social, and communication skills.

Table 5.1. National Autism Center established and emerging interventions for core, social, and communication skills
Established Emerging
Behavioral interventions Augmentative and alternative communication
Cognitive behavioral interventions Developmental relationship-based intervention
Language training (production) Functional communication training
Modeling Imitation-based intervention
Natural teaching strategies Initiation training
Parent training Language training (production and understanding)
Peer training Picture Exchange Communication System
Pivotal Response Training Sign instruction
Schedules Social communication interventions
Scripting Structured teaching interventions
Self-management interventions Technology-based interventions
Social skills interventions Theory of mind training
Story-based interventions

From the National Autism Center (2015). Findings and conclusions: National Standards Project, Phase 2. Randolph, MA: The National
Autism Center; adapted by permission.

National Professional Development Center on Autism Spectrum Disorder The NPDC was a federally
funded collaboration among three universities to identify intervention practices that have evidence of
effectiveness in promoting positive outcomes. Several phases of research literature reviews have contributed to
a list of EBPs for children, youth, and young adults with ASD (Wong et al., 2014). Resources on these EBPs
are available free on the NPDC web site. Autism Focused Intervention Resources and Modules (AFIRM;
n.d.) is an extension of NPDC. AFIRM modules provide the step-by-step process of planning, using, and
monitoring an EBP with individuals with autism from birth to 22 years of age. Table 5.2 includes
interventions identified as EBPs by NPDC (Wong et al., 2014). The table defines each practice and breaks
down available research evidence, indicating which skill areas the intervention impacted (i.e., joint attention,
play, social skills, and communication) and which age groups have benefited according to the research.

Table 5.2. National Professional Development Center on Autism Spectrum Disorder summary of evidence-based practices

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INTERVENTION APPROACHES
A polarity of viewpoints exists among the professional community as to how to meet the complex social and
communication needs of children and youth with autism. Historically, intervention approaches in the field of
autism were split between the traditional behavioral (Lovaas, 1987) and developmental (Greenspan, 1992)
models. Over the years, debate about which approach to use contributed to the merging of the applied
behavioral and developmental sciences into a more contemporary blended category referred to as naturalistic
interventions (Schreibman et al., 2015). The EBPs that are recommended for use in the field of education
range from traditional adherence to principles of applied behavioral analysis, to developmental practices in
naturalistic settings, to a more contemporary mix of the two methods. The following considerations can help
guide the selection of intervention approaches:
• If a learner with autism lacks core skills and/or learns best with a highly structured one-to-one
instructional approach, consider a traditional behavioral approach to teach new skills.
• If a learner with autism demonstrates core skills and/or learns best when actively engaged and interacting
with others, consider a developmental relationship-based approach to teach new skills.
• If a learner with autism needs support for the generalization and functional use of social and
communication skills, consider a naturalistic developmental behavioral approach.
The following sections provide descriptions of traditional behavioral approaches, developmental
approaches, and contemporary naturalistic approaches.

Traditional Behavioral-Based Approach

ABA is based on the scientific principles of learning and motivation and the interventions derived from these
principles. Over the past 40 years, thousands of research studies have documented the effectiveness of ABA
for individuals with various disabilities in different settings and for intervention to improve skills and
behaviors. ABA uses systematic procedures to assess skills and behaviors before, during, and after
intervention, with a focus on teaching socially significant, functional behaviors (Baer, Wolf, & Risley, 1968).
The practice of ABA plays a critically important role in intervention for children and youth with autism.
There are many different intervention practices based on ABA, and many of the identified EBPs in the
field of autism to date are grounded in behavioral principles. ABA practices are used to teach new skills
through systematic instruction, change the conditions under which interfering or challenging behaviors occur

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by modifying the environment, and increase socially relevant behaviors through reinforcement. Behavioral
interventions with an evidence base include strategies such as antecedent-based interventions (ABI),
differential reinforcement, DTT, extinction, FBA, functional communication training, PECS, modeling,
prompting, task analysis, and time delay (see Table 5.2 for definitions of these practices).
A common misconception is that ABA is synonymous with the particular strategy referred to as discrete
trial training. DTT, a traditional behavioral approach, is only one practice within the field of ABA and does
not represent the diverse field of behaviorism. DTT is a method pioneered by Ivar Ole Lovaas, a professor at
the University of California Los Angeles (UCLA), in the 1960s to teach children with autism. Some refer to
the traditional DTT used with children with autism as the Lovaas UCLA Model of ABA. With DTT, skills are
broken down into separate components and taught one at a time until the desired behavior is acquired. DTT
consists of one-to-one instruction using brief, repetitive discrete teaching trials with reinforcers for targeted
skill performance. The DTT model emphasizes precision and organization during instruction and includes
interventionist control over the arrangement of the learning environment. This traditional method uses
prompting (i.e., providing a cue to support skill performance), chaining (i.e., reinforcing performance of the
steps toward the complete skill), and shaping (i.e., reinforcing successful approximation of targeted skill)
techniques, and immediate reinforcing feedback contingent on the production of the correct target skill.
Traditional behavioral approaches are effective in teaching certain skills at certain times for all learners.
For example, these approaches can be used effectively to teach basic academic skills that are learned well
through precise repetition and with a highly structured instructional approach. The following vignette
provides an example of a traditional behavioral approach (e.g., discrete trial procedure) using reinforcement in
a structured environment to teach a language skill.

The teacher arranges a quiet setting to work one-to-one with a student on a vocabulary task. With the student sitting
directly across from her, the teacher holds up a photo of a common animal (e.g., dog) and says “Look. What is it?” When
the student gives the correct response, the teacher provides immediate contingent reinforcement and says, “Good! It’s a
dog” along with a motivating fist bump. She notes on her data sheet that the student has correctly named “dog.” She
then holds up the next photo (e.g., cat) and asks the same question again. “Look. What is it?” The student’s response is
incorrect, so the teacher says, “Look. It’s a cat.” She notes on her data sheet that the student has incorrectly answered
“cat.”

Intervention based on ABA should be included in an educator’s repertoire. However, it is important to

understand that concerns have been raised about the exclusive use of a strict, traditional approach to
instruction, particularly for social and communication skills. The emphasis on specific responses to adult-
directed interactions and a narrow definition of skill mastery can sometimes impede the generalized social use
of a learned skill. When using behavioral intervention to teach social and communication skills, consider
teaching in the natural environment, as skills acquired in an artificial context (e.g., therapy setting, sitting at a
table) do not always generalize to natural social contexts.
The traditional behavioral approach might assume that children with autism
• Lack social motivation
• Learn best in structured contexts
• Learn when elements of activities are controlled
• Learn through repetition of discrete skills
The following vignette provides an example of a traditional behavioral approach (e.g., discrete trial
procedure) to elicit the use of eye gaze by teaching the student a discrete skill (i.e., responding to his own
name). In this example, the teacher uses reinforcement in a structured environment.

The teacher structures the environment by setting up two chairs at a table to work one-to-one with her student. She
calls the student to the table and sits directly across from him. She gains his attention and provides a clear cue by saying
his name. She simultaneously prompts eye contact by bringing an edible reinforcer (e.g., small portion of a cracker) or
tangible reinforcer (e.g., small toy train) that he is motivated by to her eye level. When he responds and makes eye
contact for 1 second, the teacher immediately gives the contingent reinforcement to him. As skill acquisition begins to
emerge, the teacher says his name and uses time delay, providing a pause before the prompt. Throughout the teaching
sessions, the teacher provides positive reinforcement if the student looks spontaneously. She repeats the procedure,
building up longer periods of sustained eye contact from the student (e.g., 2 seconds, 3 seconds).

Developmental Approach

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The developmental model is framed within the study of typical development. Intervention emphasizes the
development of skills through active exploration and positive relationship-based interactions. The model is
based on the belief that children acquire skills through social interactions and experiences. An example of a
developmental approach includes Floortime, created by Stanley Greenspan, M.D., and Serena Wieder, Ph.D.
With Floortime, adults use meaningful learning exchanges to encourage development (Greenspan & Weider,
2006). Adults engage children through the activities the child enjoys and follow the child’s lead in opening
and closing communicative interactions. The developmental approach also uses the EBP of using parent-
implemented intervention (Hendricks, 2009), in which parents are taught how to provide individualized
intervention to their child to increase skills and/or reduce challenging behaviors in the home and/or
community. These types of models emphasize using naturally occurring situations as the context for
instruction, balancing adult- and child-directed activities, and facilitating development. The developmental
approach might assume that children with autism
• Are capable of social and emotional flexibility
• Learn through active engagement in natural contexts
• Learn through reciprocal social interactions
With developmental approaches, the child with autism is an active rather than a passive participant. The
social–communication partner may follow the child’s lead or serve as a guide in the child’s development. With
the adoption of this philosophy, interventionists target skills that are at the core of social development (e.g.,
joint attention), as well as skills that are necessary for providing a foundation for learning a wide range of
other pivotal skills (e.g., imitation, social engagement). This approach emphasizes the role of the social
relationship as an essential context for developing imitation and the foundation of social and communication
skills. The child’s internal motivation and socioemotional qualities propel active engagement, and the
responses of others to the child’s initiations and interests lay the foundation for this developmental process
approach. Intentionality and meaning are assigned to all behaviors. The rationale for using this approach to
enhance development is based on the belief that the fundamental process of learning is the same for all, so
children with autism are able to learn in natural contexts. Drawbacks of this model for children with autism
relate to the open-ended quality of the instruction. Children who lack core skills such as joint attention and
imitation or who have severe restricted, repetitive, and challenging behaviors may be less responsive to the
developmental model. The following vignette provides an example of a developmental approach (e.g.,
relationship-based procedure) to elicit the use of eye gaze during naturally occurring activities such as fun,
cooperative games.

The mother and child are in their playroom. The mother engages with her child when he is playing with a ball. She
watches his play for a while and then naturally gains possession of the ball when the child throws it. She holds the ball
near her eye level to elicit the use of her child’s eye gaze. When he looks at her, she hands or throws the ball to him. She
gives him some time to engage with the ball. She then opens her hand and gestures for him to throw the ball to her.
When she regains possession of the ball, she repeats the same steps of the activity. The mother continues to socially
engage with her child through this motivating and simple activity sequence.

Contemporary Naturalistic Intervention Approach

Whereas the traditional behavioral and developmental approaches in intervention for autism developed
separately, interventions emerged as both fields matured that were mutually informed by behavioral and
developmental principles (see Figure 5.2). Recognition that there was often a discrepancy between the highly
structured teaching strategies used in traditional behavioral approaches and the more open-ended, child-
directed developmental approaches has led to the more contemporary approach of naturalistic interventions.
Naturalistic developmental behavioral interventions are used to enhance social and communicative
competence in students with autism by integrating and combining the beneficial strategies and principles of
the traditional behavioral and developmental fields, incorporating the strengths offered by each perspective
(Schreibman et al., 2015).

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Figure 5.2. The contemporary naturalistic intervention approach.

As with traditional ABA practices, contemporary naturalistic interventions use the principles of ABA
(Franzone, 2009). Some naturalistic interventions provide explicit instruction to elicit a specific response from
the child, whereas others involve careful arrangement of the environment to facilitate initiation and
responding to cues. Naturalistic approaches that combine behavioral and developmental principles involve
setting specific goals and objectives; promote the child’s level of motivation and interest; use meaningful, age-
appropriate activities; use instructional cues and prompts in a systematic manner; and emphasize meaningful
interactions within the context of adult-structured, organized learning environments that build skill flexibility.
Some contemporary approaches focus on teaching pivotal skills (i.e., core skills that have an impact across
multiple areas of functioning) such as joint attention, gestures, and shared affect, which facilitates the later
acquisition of social and communication skills. The naturalistic approaches might assume that children with
autism
• Learn and generalize skills better when taught in natural settings
• Are motivated to learn when preferred activities are used
• Prefer to share control with the social communicative partner (i.e., teacher, parent, peer) than to always be
directed by another
• Prefer reinforcement linked to natural consequences instead of artificial noncontingent rewards (e.g.,
saying “train” and receiving a train to play with versus saying “train” and receiving food for correct labeling
of the train)
• Increase initiative and spontaneity when these behaviors are reinforced
• Respond well to a variety of behavioral strategies to teach developmentally appropriate skills
With a naturalistic approach, learning experiences are strategically designed to actively engage sustained
attention and to help students connect new experiences with existing knowledge. Naturalistic interventions
allow educators to teach within developmental sequences and systematically increase the complexity of the
learning experiences. The following vignette provides an example of a contemporary procedure to elicit the use
of eye gaze using a combination of developmental and behavioral procedures (Schreibman et al., 2015).

In the natural setting of the family home, the parent begins with a motivating and simple activity sequence. The
father engages in a playful tickling routine. He establishes predictable contingencies between the behavior (e.g., eye
contact) and the reinforcing experience (e.g., tickling). When his daughter makes eye contact with him, he immediately
reinforces her with the natural consequence of tickles. He makes the reinforcement contingent on his daughter making
eye contact with him (i.e., the social partner). He does not tickle her until she makes eye contact. He incorporates
behavioral strategies such as prompting (e.g., calls her name initially and then fades prompt) and reinforcement (e.g.,
tickling) to maintain the skill. Once eye contact has been occurring consistently, the father adds a second skill (e.g., use
eye gaze to follow the gesture of pointing) to elicit during the reinforcing activity. As his daughter uses each precise skill
within the activity, he continues to use the reinforcing activity to expand communication, the complexity of the skills,
the social demands, and/or the number of action sequences within the routine. For example, the interaction evolves into
a game in which she imitates her dad touching a body part (e.g., nose, eyes, mouth), then he tickles her, and then they
do a high five—continually expanding the social interaction.

Contemporary methods that draw from both behavioral and developmental learning principles help to
enhance skills in natural settings. In many contemporary ABA models, in-home and center-based one-to-one
instruction is paired with facilitated peer play and support in inclusive general education classrooms. These
ABA models emphasize generalization activities for transfer of skills to natural environments. Box 5.1
includes a list of naturalistic interventions. This list is not exhaustive, but includes some of the research-based
interventions that fall within this continuum of options.

Box 5.1. Naturalistic interventions

• Incidental teaching (Hart & Risley, 1982; McGee & Daly, 2007; McGee, Krantz, Mason, &
McClannahan, 1983)
• Interaction routines (Quill, 1995)
• Pivotal Response Training (PRT; Koegel & Koegel, 2006)
• Early Start Denver Model (ESDM; Dawson et al., 2010)

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 • Reciprocal imitation training (RIT; Ingersoll, 2010)
• Project ImPACT—Improving Parents as Communication Teachers (Ingersoll & Wainer, 2013)
• Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER; Kaale, Fagerland, Martinsen,
& Smith, 2014; Kasari et al., 2014)
• Early Achievements (Landa & Kalb, 2012)

Research has demonstrated that naturalistic interventions are conducive to promoting social development
because they involve interactive exchanges between the child and a social partner such as a typically developing
peer (Morrier, McGee, & Daly, 2009). Natural procedures, such as embedding intervention into daily
routines and preferred activities, increase both the quantity and the quality of learning experiences
(Schreibman & Koegel, 2005). Naturalistic approaches transform motivating play or familiar daily life
routines between the child and the social partner into learning sequences.
Additionally, in contrast to highly structured approaches, naturalistic interventions emphasize the
integration of knowledge and skills across developmental domains (e.g., social, communication) and promote
generalization of newly learned skills throughout the intervention process. From the beginning, the goal is to
build on a skill learned in one domain (e.g., communication) and context (e.g., learning a new word or gesture
during one activity with one person) and apply and expand that skill to development in other domains (e.g.,
socialization) and contexts (e.g., using the word or gesture to sustain engagement during social activities with
another person).
Rather than teaching skills discretely and in isolation, naturalistic approaches involve teaching skills within
typical daily interactions, experiences, and routines (e.g., meals, baths, playtime), with multiple materials and
by multiple people (e.g., parents, siblings, peers). When the child generalizes the skill to multiple settings and
people, he or she understands that the skill has meaning and leads to desirable natural consequences.
Naturalistic approaches provide a framework to support efficient and effective learning involving everyday
functional skills, particularly social–communication, via interactive, meaningful exchanges. Intervention
focuses on developing knowledge and abilities that have been shown to be pivotal core skills that enhance
developmental achievements. Two examples are joint attention and imitation.
Although social and communication skills can be enhanced through approaches that draw from the best of
behavioral and developmental principles, when selecting intervention strategies, it is important to consider the
diversity of target goals and social contexts as well as the characteristics of a particular child with autism. To
do this, one must consider the appropriateness of a particular approach for facilitating a particular skill.

Selection of an Intervention Approach

When selecting intervention approaches, it is necessary to consider each child’s level of motivation, attention,
and organization in each learning environment. After selection, there is a need for ongoing evaluation and
adjustment of approaches, sometimes moment to moment, based on the child’s behavioral state and skills. An
eclectic approach to social and communication enhancement, in which intervention methods used for a child
with autism vary according to intervention goals, social context, and other specific factors, seems to be the
most logical solution to build socialization and communication. This approach to social and communication
enhancement requires ongoing decision making about which approaches will best fit the individual’s needs. A
familiarity with the benefits and drawbacks of each of the three main intervention approaches discussed in this
chapter can be a very helpful beginning. To ensure that intervention is effective, build in spontaneity and
develop opportunities for self-initiation of new skills. Plan for generalization of the skill across multiple
contexts such as environments, materials, and people.
Box 5.2 provides examples of how to apply interventions from all three approaches to teach imitation,
organized along a continuum of most to least adult-directed intervention methods. These examples provide
some insight into how the various intervention approaches might be applied to skill development.

Box 5.2. Applying different intervention approaches to skill development

The following examples represent a continuum of behavioral and developmental approaches to teach
motor imitation during a simple art activity, and they are described from most to least adult directed.
• Behavioral 1: Discrete trial—Direct learner to do multiple repetitions of an action. Sit across from
learner at a table. Establish attending. Model, drawing a vertical stroke while presenting the verbal
instruction, “Do this.” Prompt learner to imitate the stroke. Reinforce learner. Repeat trials until

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 learner makes the vertical stroke on direction.
• Behavioral 2: Prompted direct instruction—Use video modeling instruction prior to the activity, then
systematically model during the activity. Create a video detailing and modeling the steps necessary to
imitate targeted strokes. If learner is being taught to imitate a sequence to draw a tree, the instructional
video could present the following task-analyzed five-step imitation sequence: 1) “Get the brown
crayon” while the person in the video models picking up the crayon. 2) “Do this. Draw a line down”
while the person in the video models drawing a line. 3) “Do this. Draw another line down” while the
person in the video models drawing a second vertical line. 4) “Get the green crayon” while the person
in the video models picking up a green crayon. 5) “Do this. Draw a circle on top” while the person in
the video models drawing three circles above the two vertical lines. After watching the video, organize
paper and crayons in front of learner. Sit across from learner. The adult and learner each have their
own set of art materials. Model the five steps of drawing a tree, one step at a time. Use the simple
verbal cues as heard on the video and pair them with a corresponding action. Prompt learner through
the targeted imitation skill, as needed. Give verbal or tangible reinforcement contingent on learner’s
successful imitation of each step.
• Behavioral-Developmental 1: Prompted turn taking—Establish a turn-taking routine using objects,
and prompt multiple repetitions of one or more actions during a structured adult-directed activity. Sit
learner at an easel with paper, but do not give him or her a pencil. Gain learner’s attention and model,
drawing vertical strokes on the paper. Then, stop drawing, give learner the pencil, and prompt him or
her to imitate the strokes. Continue to take turns.
• Behavioral-Developmental 2: Shaping—Shape learner’s initiations into purposeful action. Give
learner a pencil, and sit him or her at an easel with paper. Wait to see what learner does. As learner
scribbles on the paper, follow his or her lead but shape learner’s actions into more purposeful or desired
strokes. If learner scribbles in a circular motion, interrupt his or her circular stroke after one rotation to
form a circle. Label the shape formed (e.g., “It’s a circle,” “You made a circle”). Then, take turns
forming circles. Sound effects also may be used to shape scribbling into more purposeful drawing:
Attach a reinforcing noise to the action and a “stop” sound effect to end the stroke. For example, roll
the tongue while making circular strokes and then make a braking noise when ending the stroke.
• Behavioral-Developmental 3: Scaffolding—Imitate learner and scaffold this into expanded actions.
Give learner a pencil and sit him or her at the easel with paper. Wait to see what learner does. As he or
she scribbles on the paper, follow his or her lead but use modeling to extend the scribbles into strokes
(or any drawing element being targeted for teaching). For example, if learner draws two vertical lines
on the paper, imitate him or her. Then model, drawing circular scribbles on top to form a tree. The
difference between shaping and scaffolding is that scaffolding extends the action into another action,
whereas shaping simply forms targeted actions from already existing ones.
• Developmental 1: Turn-taking imitation—Imitate learner’s action(s). Give learner a pencil and sit him
or her at an easel with paper. Wait to see what learner does. After he or she marks the paper, wait until
learner stops. Then, imitate his or her stroke. Continue to take turns scribbling on the paper with
learner. Any verbal input should be limited to commenting on the learner’s actions and then on the
instructor’s.
• Developmental 2: Simultaneous imitation—Imitate simultaneous action, following learner’s initiation.
Give learner a pencil and sit him or her at an easel with paper. Wait to see what learner does. When he
or she begins scribbling, imitate his or her strokes. Stop when learner stops drawing. Keep instructor
activities in unison with learner’s. Do not give direction or instruction to learner. Follow the learner’s
lead throughout the activity. Any verbal input should be limited to commenting on the learner’s
actions.

SUMMARY
This chapter reviewed the current state of intervention research for autism and detailed some specific
approaches and EBPs for promoting social and communication skills. Our understanding of which practices
have an impact on positive outcomes for individuals with autism is continually evolving, and a number of
additional EBPs likely will prove fruitful in the near future as more research is completed. The chapter
discussed three critical approaches to intervention—traditional behavioral, developmental, and contemporary
naturalistic—and also outlined some of the EBPs currently available, including comprehensive intervention
models that broadly address the core challenges in autism and more focused interventions related to specific
skills. Guidelines for selecting interventions were also provided.

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 In sum, remember the following points when selecting interventions to support social and communication
development:
• Prioritize the use of EBPs for intervention.
• Understand the continuum of intervention options:
• Behavioral principles, which are adult-directed and require precision and structure
• Developmental principles, which are child-directed and relationship-based and focus on natural
contexts for social interactions
• Naturalistic principles, which are a combination of developmental and behavioral principles
• Define a successful intervention. If it is believed that a method is working for a child with autism, define
and document the success. For example, in the case of social and communication development, an
intervention is effective when the child spontaneously uses social and communication skills across familiar
and novel situations.
• Constantly reevaluate why a specific procedure is being used. Interventions that produced positive
outcomes in the past do not necessarily need to be used in the present.
Above all, remember that autism is complex. It is unlikely that a singular intervention approach will work
for all social and communication challenges. Intervention approaches and EBPs will work differently with
each individual and should be implemented flexibly. What is most effective for enhancing an individual’s
social–communicative competence might change over time, depending on the social context, the skill being
taught, or the person’s present needs and goals. Intervention decisions should be based on both evidence-
based research and professional judgment, with the characteristics, needs, preferences, and well-being of the
child with autism first and foremost in mind.

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 CHAPTER 6

Instructional Strategies to Enhance Social and

Communication Skills

LEARNING GOALS:
1. Learn how to use instructional strategies to enhance social and communication skills and meet the needs
of students with autism.
• Describe how to set up a learning environment and use intervention strategies to provide optimal
teaching opportunities.
• Describe how to plan activities that promote optimal engagement in social interactions and
communication and provide opportunities to teach skills.
• Describe the range of behaviorally based instructional strategies to teach targeted skills in the
intervention plan, working toward generalization of functional social and communication skills.

T his chapter examines a range of specific instructional strategies for students with autism, with a focus
on helping professionals and families create opportunities to build social and communication skills.
The instructional strategies in this chapter represent a broad range of clinical research practices for
students with autism and are discussed as a continuum of intervention options. Access to a continuum of
intervention strategies is necessary to account for the complexities of social and communication development
and the significant diversity that is found among children and youth with autism. The task of building social
and communication skills in children with autism is a difficult one, and as such this chapter offers guidelines
for intervention that are not intended to be definitive or dogmatic.
There are a variety of evidence-based best practice strategies and supports that can be integrated into an
intervention plan to promote social and communication development. In order to determine what
interventions to select, it is essential to examine the specific goals and objectives for skill acquisition (i.e.,
whether the skill is emerging, mastered, or generalized) along with the individual’s social motivation, skill
repertoire, and behavioral obstacles. The key instructional considerations discussed at length in this chapter
are 1) planning optimal teaching opportunities and 2) providing explicit instruction based on principles of
ABA.

TEACHING OPPORTUNITIES
Planning optimal teaching opportunities for social and communication skill instruction includes arrangement
of the learning environment and selection of specific activities to teach social and communication skills. This
process requires an understanding of 1) the principles of UDL and 2) instructional adaptations, including
accommodations and modifications. With these understandings, the social context, setting, and activities can
be arranged to maximize social learning.

Universal Design for Learning

UDL is a scientifically valid framework guiding educational practice that can be customized and adjusted to
meet individual needs. UDL

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• Provides flexibility in how learners are engaged, how information is presented, and how learners
demonstrate knowledge and skills
• Reduces barriers in instruction, provides needed supports, and maintains high expectations for all learners,
including students with autism
• Provides a blueprint for designing instruction that creates opportunities for access, participation, and
progress in the classroom for all students
The Center for Applied Special Technology (CAST, n.d.; Myer, Rose, & Gordon, 2014) is a resource for
information related to UDL. CAST believes that learning barriers are not inherent in the learner but instead
arise as a result of inflexible educational methods, materials, and assessments. When teachers create a
classroom environment, an instructional plan, or an assessment using UDL principles, they proactively design
flexible approaches that can be customized and adjusted for individual needs and do not rely on a single, one-
size-fits-all method. UDL emphasizes three aspects of differentiated instruction: 1) multiple means to engage
learners, 2) multiple means to present information, and 3) multiple means for learners to demonstrate
understanding. For example, using the UDL framework, a teacher presents information and content in
different ways, seeking to meet the learning styles of diverse learners. In advance, the teacher plans ways to
differentiate how learners can express what they know. In addition, the teacher plans student engagement to
ensure that learners not only are engaged but stay motivated. When planning intervention for students with
autism, the principles of UDL can be used proactively to design instructional opportunities that meet the
needs of all learners. The following vignette illustrates how the principles of UDL can be applied to
intervention planning.

The teacher plans a group project to provide social opportunities for a student with autism. The student with autism is
interested in trains. The group is assigned a project on Japan, and the teacher includes a requirement for the
assignment to include transportation (e.g., bullet train). When presenting the lesson on Japan, the teacher uses both an
oral lecture and visuals so that information is presented in multiple ways. The teacher allows the student with autism
to draw a map of Japan’s train routes instead of having to do an oral presentation to demonstrate his understanding.

Adaptations: Accommodations and Modifications

Adaptations are defined as changes made to the learning environment, curriculum, instruction, and/or
assessment practices in order for a student to be a successful learner. Adaptations allow learners to have equal
access to the environment and information. They include accommodations and modifications and are based
on individual student needs. Some adaptations do not fundamentally alter or lower standards or expectations in
instruction, engagement, or assessment. These are referred to as accommodations. Some adaptations do alter or
lower standards or expectations, and these are referred to as modifications. When instructors use the UDL
framework, lessons and classroom environments are designed with learners’ needs in mind from the start,
which can reduce the number of adaptations needed or even eliminate the need to create them.

Environmental Arrangement
The principles of UDL can be used to design learning environments that support all learners. Every social
context, setting, activity, and instructional moment has the potential to include opportunities that enhance
social and communication skills (see Table 6.1 for an overview of considerations for designing the learning
environment). Activities and social interactions should be structured to create maximal learning opportunities.
The temperament of an individual (i.e., sensory sensitivities, restricted and repetitive behaviors, and emotional
temperament) is taken into account to determine what adaptations to the environment must be made. For
example, classroom accommodations for a student who is sensitive to touch may include sitting close to the
teacher rather than peers, being first or last in line with a group of peers, being given choices of what
manipulative materials to use (e.g., writing or art activities), changing the location of school lockers, and more.
Small changes to the environment can minimize the student’s discomfort and maximize social and
communication opportunities. More details about arranging the social context, setting, and activities follow.

Table 6.1. Considerations to prepare the learning environment

Prepare the learning environment Considerations
Select social context: Social communication is more likely to occur in one-to-one interactions.
One-to-one Group expectations (not size) determine the probability of success.
Group Skills are generally acquired first with adults and generalized to peers.
Small
Large
Adult partner
Peer partner(s)
Select type of setting: Adapt the environment to accommodate sensory sensitivities.

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Sensory-sensitive Orchestrate opportunities for semistructured interactions.
Structured Embed learning in the most natural setting possible for automatic generalization of skills.
Single setting Use every moment at school, at home, and in the community as a teachable moment.
Multiple settings
Semistructured
Single setting
Multiple settings
Natural
Single setting
Multiple settings
Select type of activity: Select activities that are:
Closed-ended Motivating
Open-ended Meaningful
Age appropriate

Select Social Context Given that difficulties with social understanding and communication are central to
autism, it is imperative to consider the social context when teaching new skills. Consider the following two
questions when arranging the social context to support social and communication skill development:
• Should intervention occur in one-to-one or in small- or large-group settings?
• Should intervention be conducted with adults and/or peers?
Depending on the targeted skills, there are some helpful guidelines for how to decide on the social
environment (i.e., one-to-one, small group, or large group) and select social partners for social–communicative
intervention:
• If the goal is participation in social activities (DO-WATCH), first introduce the skill in a one-to-one
setting with an adult. After the initial acquisition of the skill, practice the skill in a partner activity with
one peer partner and then generalize the skill to a group setting. The adult’s role will shift from social
partner to the facilitator of child–peer interactions.
• If the goal is communication (LISTEN-SAY), first arrange the initial interactions with an adult to
practice the skill. After the initial acquisition of the skill with an adult, practice the skill with a peer
partner, and then practice the skill in a variety of small-group and large-group social contexts. The adult’s
role will shift from communication partner to the facilitator of child–peer interactions.
The child’s ability to acquire new social and communication skills will vary across activities. When the
child is struggling to learn a new skill in a particular setting, it is helpful to consider the different social
contexts as a hierarchy, from most to least support. Figure 6.1 illustrates various arrangements of the social
context for teaching and practicing skills organized according to this hierarchy.

Figure 6.1. Hierarchy of social contexts.

When considering social contexts for teaching and practicing skills, remember that social or group
dynamics strongly affect successful participation and opportunities to learn for students with autism.
Participation in social situations is sometimes less influenced by the size of the group than by the expectations.
The unspoken social rules that exist in almost any setting where there is more than one person are challenging
for many people with autism. The need to wait or take turns while talking or doing an activity often is not
understood or is confusing. The individual’s ability to participate and learn new skills in a social or group
activity often can be determined by two key factors: social predictability and communication expectations. The
levels of clarity and social predictability within the activity or setting should be considered when planning
teaching opportunities.
• If the student requires clarity with social expectations (what to DO), modify activities so that everyone in
the group is doing the same thing at the same time with little or no waiting, and ensure that the student
with autism has his or her own set of materials.
• If the student understands what to DO but requires support to wait or take turns (whom to WATCH),
structure activities to increase the level of predictable turn taking. The child’s ability to demonstrate joint

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 attention in a peer group will contribute to his or her level of engagement. Keep in mind that requirements
to observe others and wait to take a turn increase relative to the size of the group. For example, an
individual waits for approximately 50% of the time in an activity consisting of two people (dyad). However,
if the group consists of 10 people who are taking turns, it is likely that the individual will need to
WATCH and wait to take a turn for 90% of the activity.
The communication expectations also vary across social or group activities. Language comprehension is
required to participate in some activities, whereas other situations do not require an understanding of the
language in order to participate. Examine the communication expectations of the activity in relation to the
child’s communication and language comprehension abilities.
• If the child with autism has limited language comprehension skills (LISTEN), select activities in which an
understanding of language is not required in order to participate, even though talking occurs (i.e., during
snack time). Ensure that the child knows what to DO before targeting communication skills in the setting.
• If the child has language comprehension skills and understands what to DO, select activities that require
discussion (SAY) in order for the child to practice communication skills.
Recall that the general types of group activities include, from least challenging to most challenging: 1)
unison, 2) choral, 3) structured nonverbal turn taking, 4) structured verbal turn taking, 5) unstructured play,
and 6) discussion. Identify the type of group activities in which the child is most successful and the contexts in
which social and communication intervention goals should be addressed. If the child with autism is not
successful with any of the group contexts, begin with unison activities.
Finally, the characteristics and abilities of the student with autism must be taken into account to
determine the relevance of a particular activity as a context for learning. Always review assessment data (e.g.,
ASCS-2) to consider the degree to which the child demonstrates joint attention in different social groups and
is able to imitate a sequence of motor and/or verbal acts in natural contexts. The presence or absence of these
core skills largely determines the approach to social and communication enhancement. The ability to use these
core skills in different settings and with different social partners will influence the degree to which specific
instructional strategies and supports will be used with the child:
• Core skills are absent: If joint attention and imitation are absent, intervention must include more highly
structured activities, better organization of the physical environment, more adult-directed activities, and
more explicit adult instruction.
• Core skills are present: If joint attention and imitation skills are present, intervention can include less-
structured activities, more group turn-taking activities, and greater use of adult and peer modeling.
The following vignettes illustrate how core skill abilities and group dynamics determine the
appropriateness of various activities for children with autism.

Joseph attends a specialized program for children with autism. He is able to engage in parallel activities when he has
his own set of materials; he does not observe his peers during these activities. Joseph is able to participate in group
activities when all of the individuals are doing the same thing at the same time and there is no waiting. During these
unison and choral groups, he observes his peers and imitates everyone in the group. His ability to observe and imitate
peers is linked to the level of social predictability in the group activity.

Samantha spends half of her school day in an inclusive general education classroom. She observes and imitates peers
during structured art projects and during academics when everyone is doing the same thing at the same time. She
communicates with peers during lunch and with one friend during structured activities. Samantha can attend while
her teacher reads or lectures to the class, but she loses focus when the group engages in discussion about the lesson. She
also has difficulty during group meeting times that involve random turn taking. In addition, Samantha isolates herself
during unstructured free time. Her ability to interact with peers is linked to the level of social predictability and the
level of language complexity in the group activity.

Arrange Setting Decisions about where interventions will occur must take into account the target goals,
the setting variables, and the characteristics of the student with autism. A key to successful intervention for
social and communication skills is to recognize that every moment, regardless of setting, is a teachable
moment to focus on the target goals.
Typically, social and communication skills will have greater meaning and be acquired more rapidly if
learned in natural settings. All settings can be structured and orchestrated to create opportunities for acquiring
skills. Some children or target goals may require the setting to be highly structured for the skill to be acquired,

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whereas other skills can be learned in more unstructured and natural settings. If a skill is first learned in a
contrived or structured setting, the skill needs to be practiced in additional structured, semistructured, and
natural settings to ensure mastery and generalization.
The highly structured setting is associated with the traditional behavioral method in which the adult
directs the activity and uses explicit instruction; a natural setting is analogous to the developmental method in
which naturally occurring events and social interactions are used as teaching opportunities; and a
semistructured activity is associated with the behavioral-developmental model in which naturally occurring
events and social interactions are structured to plan teaching opportunities (see Figure 6.2). The more
structured setting provides the student with the fewest environmental distractions and the most support. In
contrast, the natural setting may have the most distractions, which can be problematic for children with
sensory sensitivities and difficulty with social attention.

Figure 6.2. Social Settings.

Intervention must occur across multiple settings (e.g., school, home, community). All of the skills
addressed in this text require ongoing intervention and continual practice with everyone who interacts with
the child with autism. Keep in mind individual temperament and core skill abilities when selecting the
optimal setting for teaching new skills. Some important considerations are as follows:
• Sensory sensitivities: If the child with autism has difficulty participating because of sensory sensitivities
(e.g., sensitive to noisy, active settings), arrange the environment to have less sensory input (e.g., quieter,
less-busy setting). Select settings in which the child is calm, organized, and self-regulated.
• Anxiety: Ensure that the setting is not causing anxiety. If the child engages in restricted or repetitive
behaviors or is experiencing anxiety, arrange a more structured, predictable environment. Whenever
possible, identify settings where there is an absence of restricted and repetitive behaviors.
• Problem behaviors: If the child engages in challenging behaviors, arrange the environment to mirror
conditions where this behavior is least likely to occur. Identify settings where problem behaviors are less
likely to occur for opportunities to practice target social and communication skills.
• Social motivation: If the child watches, imitates, and is reinforced by peers, use peer models as social
motivation in the learning environment.
• Shared attention: Examine the child’s ability to attend in adult–child and peer–peer interactions in
structured, semistructured, and natural settings. Select settings to teach new social and communication
skills in which the child demonstrates shared joint attention.
• Imitation: Examine the child’s ability to imitate one or more adults and peers in structured,
semistructured, and natural settings. The presence or absence of imitation will determine the level of
structure required to teach new skills. When imitation is present, the child will be more likely to access
teaching opportunities in all settings.
• Organization: The organized individual is calm, sustains attention to activities, attends to others, initiates
communication, and makes changes. Information about a student’s level of organizational skills can be
obtained from assessment (e.g., ASCS-2). The presence or absence of organizational skills varies from
setting to setting and from person to person. The continuum of intervention options is largely determined
by the student’s level of organization at the moment. For example, examine how the level of structure or
the number of people in the environment influences the child’s ability to demonstrate organized,
purposeful social and communication skills. If the child with autism does not demonstrate organizational
or purposeful skills, additional supports will be required for him or her to access teaching opportunities in
the setting. Organizational supports are discussed in detail in Chapter 7.
The following vignettes illustrate how individual temperaments and core skill abilities—not cognitive or
language capacities—should be used to determine the appropriateness of an intervention setting.

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Tommy is a quiet, passive student who lacks most core skills and engages in a high level of repetitive behaviors. He
struggles to share attention or respond to others’ directions, and there is an absence of motor imitation skills. Tommy is
extremely sensitive to sound. He says some words while engaging in activities alone, and his solitary activity consists of
perseverative use of objects. He generally uses simple gestures to make requests. When working with his parents and a
therapist at home in a one-to-one activity, Tommy is able to engage in functional play activities and is beginning to
make requests with intent. He imitates some actions during familiar, frequently practiced songs, and he looks at books
with another person. In an inclusive school setting, his teacher was unable to engage Tommy in the same play and
leisure activities that were successful at home. Tommy frequently climbed into one of the classroom cabinets when it
became noisy. The team decided to select quiet activities with one peer partner as the setting for targeting Tommy’s
social goals.

Caroline is nonverbal. She has frequent tantrums in response to adult directions and is more likely to respond to her
siblings and neighborhood friends. She demonstrates shared attention and watches peers, but she does not imitate them.
She appears to have no sensory sensitivities or intense repetitive behaviors. Caroline used to attend a self-contained
classroom until her parents requested some more inclusive opportunities; thus, Caroline now attends a general
education classroom with an aide. In her class, Caroline responds to the social invitations of peers, imitates peers during
structured classroom projects, initiates use of her communication board when her peers show interest, and does not
engage in challenging behaviors. Caroline’s parents report that she sleeps better and seems happier since attending the
general education class. Caroline clearly benefits from an inclusive setting where she has regular interactions with her
peers. Social interactions with peers are highly motivating for her and encourage the development of core, social, and
communication skills.

Philip is highly verbal. He is able to do academic work with significant modifications. He also is able to have simple
conversations with others about his interests, but understanding the instructions and discussion in his general
education class is difficult for him. He likes to engage in solitary leisure activities related to his favorite movies and
books. Philip has severe tactile sensitivity and becomes easily upset when there are changes in his physical environment.
At one point, Philip’s educational program was composed of a self-contained small class in the morning and attendance
in an inclusive classroom in the afternoon. After four months of intense effort, however, Philip’s family decided to
discontinue his participation in the inclusive program. Philip was displaying loud outbursts in the inclusive classroom,
frequently crying out, “I don’t like it here.” His sleep and eating patterns became disrupted as well. Philip stated that
the large social group was too stressful. Large-group work appeared to limit his ability to access new skills. He preferred
having one or two peers come to the quieter resource classroom or home to interact. Philip’s anxiety levels and sensory
sensitivities were important considerations in selecting a setting that best met his individual needs.

Select Activities Given the nature of social and communication development, every activity potentially
includes opportunities to enhance social and communication skills. Regardless of the target social or
communication goal, skills will have greater meaning and be acquired more rapidly if taught during naturally
occurring, fun, age-appropriate activities. However, most activities will need to be structured and orchestrated
to create teaching opportunities for children with autism. In addition, closed-ended activities are more likely
to meet the needs of the child. Whenever possible, ensure that the setting and activities are motivating and
meaningful. See Chapter 8 for a rich collection of activities in which to embed instruction on core, social, and
communication skills for students with autism. Motivating and meaningful activities in natural environments
promote and build spontaneous social and communication skills.
Closed- or Open-Ended Activities Social activities can be closed- or open-ended. Activities that lack
predictability or are open-ended can be confusing for children with autism and often are not the best
opportunities to facilitate social and communication skills. Children with autism will vary in their ability to
participate in open-ended activities in purposeful and flexible ways. The presence or absence of core skills—
specifically, shared attention, imitation, and organization—will directly affect the individual’s success or
difficulty with open-ended activities. Consider a child’s core skill abilities when determining whether a
particular closed- or open-ended activity is a viable opportunity for social interaction and communication
enhancement.
In general, closed-ended activities have a clear purpose, organization, and a final product or clear
completion point. In contrast, open-ended activities generally lack specific rules, allow for the creative use of
materials, have no set sequence of events, and do not include a final product.
• If the child has an absence of core skills and/or is inflexible, plan for participation in closed-ended
activities.

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• If the child possesses core skills and is flexible, consider participation in open-ended activities as an option.
The lack of organization inherent in open-ended activities often is challenging for most individuals with
autism. All activities, open- or closed-ended, can be further organized and more highly structured to create
greater predictability. The following vignette illustrates closed- and open-ended activity participation.

Maura and Bertha are two students with autism. The school team created a plan for recess because both girls struggle to
play with the other children during this time. Maura observes, imitates, and likes to interact with her peers, but she
only talks about her favorite TV character, continuously asking peers the same question and then turning away from
them. The recess plan included an adult facilitating Maura’s participation in a number of semistructured, open-ended
games, such as Four Square, jump rope, and Mother-May-I, which were enjoyed by all of the children. An alternative
plan was needed for Bertha, who isolated herself at recess and engaged in self-stimulatory repetitive behaviors. Bertha
did not watch, imitate, or interact with peers. The plan included an adult facilitating closed-ended games with three
peer partners. The peers volunteered before recess (i.e., “Who wants to play ______ today?”). The small group
participated in partner relay races using various props, which made the games fun for everyone.

Motivating Activities Motivating activities can be defined as purposeful and meaningful activities in
which social interactions are most likely to occur. Motivation is obviously linked with personal interests.
Motivation also is intimately linked to understanding the purpose of an activity. When a child with autism
understands what to DO in any situation, it increases the likelihood that he or she will interact with others.
Social understanding, or an understanding of how to interact with others (WATCH-LISTEN), also is
naturally linked to motivation. Misunderstanding the intentions and behaviors of others accounts for many of
the social struggles common to children with autism and influences their motivation to participate and engage
in social activities. As such, motivation is affected by the type of activity, the social partners, and the
complexity of the social interaction. The intervention plan should incorporate those types of activities in
which the child is most successful as opportunities for building social and communication skills. It also is
important to consider the stylistic patterns of the adults and peers with whom the child is most interactive and
choose social partners who are compatible in terms of interaction style and interests. Finally, monitor the
child’s emotional state during activities to determine which activities and interactions are most motivating.
Social motivation and participation occur when the social environment is meaningful and pleasurable for both
the child and others.
Motivating activities are likely to elicit positive opportunities for social engagement and communication.
Interests are a window into what makes sense to an individual; that is, an individual engages in activities that
provide stimulation, comfort, and meaningful information. It is important to frequently do an inventory of the
child’s s motivations and interests (e.g., using tools such as the ASCS-2 Behavior Profile) that includes
information about motivating activities, sensory preferences, and social partners with whom the child with
autism is most interactive. When selecting activities to motivate learning, use assessment information and ask
the following questions:
• Are there opportunities to target social and communication skills within preferred activities?
• Are the child’s preferred activities open- or closed-ended?
• Does the structure of the activity influence social participation?
• Does interaction improve during active or passive activities; for example, does movement foster more
interaction or create more disorganization?
• In what situations is the child with autism most interactive with others?
• What are the stylistic characteristics of social partners who successfully interact with the individual?
Assessment information can be used to adapt activities and modify the interaction patterns of adult and
peer partners to increase motivation. Consider
• Embedding a child’s interests and preferences into a less-motivating social activity
• Using solitary play and leisure interests as contexts for social interaction with others
• Using social activities that the child has mastered with adults as opportunities to interact with peers
• Pairing new activities with preferred objects or people to enhance motivation
Individuals with autism vary significantly in their ability to stay calm and organized in various settings.
Sensory sensitivities and degree of anxiety often can determine whether the person is active, passive, or

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anxious, and/or expresses restricted or repetitive behaviors during activities. Activity level and degree of
restricted and repetitive behaviors may be expressions of comfort level. These factors—anxiety, sensory
sensitivities, and comfort level—should be considered when selecting activities. To discern what factors may
contribute to a particular student’s level of comfort and ability to access teaching opportunities, review
assessment information and consider the following questions:
• What sensory stimuli does the child seek and avoid?
• When does the child engage in restricted or repetitive self-stimulatory behaviors? When are these
behaviors least likely to occur?
• When does the child engage in restricted or repetitive social interactions? When are these behaviors least
likely to occur?
• What does the child do to calm himself or herself?
If the child needs assistance with focus, organization, and self-regulation, enhance motivation to
participate in selected activities through the use of various instructional supports (i.e., organizational, social,
and communication supports) described in detail in the following chapter.
Finally, a distinction needs to be made between an individual’s repertoire of motivators and his or her
intense interests or passions. Sometimes, the child’s intense interests may be motivating opportunities for
learning, but sometimes they are not. It is important to monitor students’ emotional state and behaviors when
engaged in intense interests to make sure they do not become consumed by their enthusiasms at the expense
of learning. An intense interest may be used as a teaching opportunity and embedded into different activities
if the student can 1) share a strong interest with others in a flexible manner and 2) disengage from an activity
associated with the intense passion without disruption. Nonetheless, one may need to be cautious in using
special interests as part of an intervention plan. The following vignettes illustrate both positive and negative
results of using obsessive interests to motivate children with autism.

Robert is fascinated by robots and talks about them incessantly. His teacher used his intense interest in positive ways.
She used robot stickers as rewards. She arranged a daily activity for Robert and one classmate to draw a picture and
write a story about different types of robots. Positive interactions and conversations occurred as Robert and his peers
worked together on these projects. By the end of the school year, the class had generated a robot encyclopedia.

Don is extremely interested in vending machines; he talks nonstop about the one in school. Initially, Don was given an
opportunity with a friend each day to fill the vending machine; however, he became increasingly more anxious while
waiting for his next opportunity to do this. Don’s inability to control this obsession resulted in a dramatic increase of
his running out of the classroom to the vending machine, which then escalated into screaming in the classroom.
Therefore, access to and discussion about the vending machine had to be eliminated completely. The teachers wrote a
story for the class about the vending machines being for teachers only. A “Do Not Enter” sign was placed on the room
with the vending machine, and a new behavior contract with different rewards was designed for Don.

Meaningful Activities The ability to sustain attention and to participate spontaneously in an activity is
linked to the activity’s meaningfulness for the individual. Meaningful activities are essential to social and
communication success, because social interactions are more likely to occur in the context of purposeful and
meaningful activities. The challenge of intervention is to select age-appropriate, meaningful activities and then
superimpose elements of structure and organization into them. The activity should be inherently reinforcing
whenever possible. Remember also that structured, organized, predictable, and somewhat repetitious activities
can be both meaningful and fun. The following vignettes illustrate how target social and communication goals
can be structured into meaningful, fun activities. The first sample activity was selected for a child whose goal
was to increase imitation skills. The second sample activity was used for a child whose goal was to increase
commenting communication skills.

In physical education class, the students begin doing warm-up exercises. Five different stretch positions and actions are
practiced with Edgar, who is learning to imitate motor actions across a wide range of meaningful activities. The large
group of peers serves as his model, and the adult prompts the contextually meaningful actions.

A book share is structured to elicit communication with Sheldon. The teacher selects an age-appropriate picture book
about a topic of interest. The teacher and Sheldon take turns pointing to and labeling the objects in the book in a
predictable way. The teacher looks through the entire book with Sheldon, pointing to and labeling one item per page.
Next, the teacher starts the book again and establishes a turn-taking routine so that the adult and student take turns

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naming one item on each page. For example, when using a book about animals, the teacher points to an animal on
page one and says, “(name of animal).” Then she points to the animal on the next page and waits for Sheldon to label
or comment. The teacher uses prompts as needed to elicit commenting.

In summary, intervention must take into account the settings, activities, and interactive partners that offer
positive social experiences for the child with autism. These positive characteristics need to be duplicated across
as many social contexts as possible to enhance comfort and, thus, to facilitate social–communicative
competence. The characteristics of the setting that may contribute to level of comfort include the social
dynamic (e.g., size and makeup of the group), physical environment (e.g., closed-ended or open-ended), and
activity (e.g., active or quiet; predictable or creative). The characteristics of the interactive partners that may
contribute to an individual’s level of comfort include style (e.g., simple or complex language use; animated or
calm; use of prompts and cues) and timing (e.g., slow- or fast-paced). In the absence of comfort, a child with
autism is more likely to engage in challenging behaviors. When the individual is unable to focus or participate
in a social context, this generally results from feeling confused either by the activity or by the social
expectations.

EXPLICIT INSTRUCTION AND INTERACTIONS

Once teaching opportunities have been identified and the educational team has carefully considered how to
structure the social context, activities, and appropriate settings for social and communication instruction, it is
important to use proven instructional strategies to teach skills. There is a wealth of useful resources that
discuss behaviorally based instructional methods in detail (see Alberto & Troutman, 2016, for a
comprehensive review). This section will summarize explicit instruction and three basic behavioral strategies:
cues, prompts, and consequences. Instructional strategies based on principles of ABA have been well
documented with regard to their utility in teaching students with autism (NSP2, 2015). These behaviorally
based instructional strategies can be applied across all settings in myriad ways—in natural interactions, in
incidental teaching, or during activity-based instruction. Given the learning style of many children with
autism, misinterpretation of verbal and nonverbal information and/or attending to irrelevant or less-salient
aspects of the social environment are common. Therefore, it is important to teach using explicit instruction,
cues, prompts, and consequences.

Explicit Instruction
The terms explicit instruction and systematic instruction are used interchangeably. Explicit instruction is concise,
unambiguous, and specific. Explicit instruction provides direct instruction to teach a new behavior or skill and
includes the systematic application of cues, prompts, and consequences. When using explicit instruction,
define and directly teach a skill, systematically guide the student through application of the skill, and provide
guided practice until mastery and generalization are achieved.

Systematic Use of Cues

Cues are visual, auditory, tactile, or any other sensory events that signal a response. Cues can be environmental
or social, and they can be natural or contrived. A natural environmental cue is anything in the physical
environment that triggers a response. For example, a curb at the end of the street triggers a response to stop
before crossing. In order to respond to natural cues, it is necessary to scan the environment, notice what is
relevant, and understand the meaning of the natural cues. Attending to relevant natural cues and
understanding their meanings are challenging for many individuals with autism. In the previous example of
the curb, an individual with autism who does not stop before crossing the street may not notice the curb, may
not understand the purpose of the curb, or may not understand what to do at the curb.
A contrived environmental cue is anything that is added to the physical environment to assist an individual
in attending to relevant information and in understanding the meaning of the physical setting. In the previous
example, the addition of a “Walk–Don’t Walk” signal at a street corner is an example of a contrived
environmental cue that triggers a person to stop before crossing. Individuals with autism often benefit from
the use of contrived cues in the physical environment.
Natural social cues are anything that a person says or does that triggers a response, including the words,
gestures, touches, and facial expressions that occur during natural interactions. In order to respond to natural
cues, it is necessary to attend to others, notice what is relevant, and understand the meaning of the natural
social cues presented. Individuals with autism may struggle with attending to relevant social cues and
understanding their meanings, since the inability to attend to multiple social cues and to understand the intent

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and meaning of others’ behaviors lies at the heart of autism.
A contrived social cue is any adaptation that a person makes in words or in actions to increase an
individual’s social attention and comprehension of social meaning. Examples are the use of exaggerated facial
expressions or gestures, and exaggerated voice inflections.
The precise, systematic use of environmental and social cues is an essential strategy to use during planned
instruction and natural interactions. The student’s ability or inability to focus attention on relevant natural
cues at any moment determines whether more salient environmental and social cues need to be provided.
Children with autism often have difficulty attending to relevant cues, focus their attention on the wrong
cue, and/or have difficulty attending to multiple cues simultaneously. The following vignettes exemplify these
characteristics.

Noah was walking down the hallway at school to deliver a message to the office. A group of students was heading
toward him. Instead of walking around them, Noah walked right through the middle of the group, bumping the
students. He appeared to be unaware of their presence. The relevant social cues of the situation eluded him.

Donna watches cartoons on television. In one cartoon episode, there was a fire and the television character said, “This
is serious.” Now, whenever Donna sees steam (e.g., from food cooking on the stove) or smoke in any context, that
environmental cue triggers her to say, “This is serious.” She attended to the wrong cues to determine the meaning of the
phrase This is serious.

Will is easily distracted, even in the most structured social contexts. When the physical setting and activity were
organized for solitary play, Will continued to lose attention. The additional use of reinforcement was minimally
effective. However, there was a marked improvement in Will’s ability to maintain attention to his play activity when
verbal cues were eliminated from the social context and he only needed to focus on one relevant cue (i.e., his toy). Will
currently is unable to attend to multiple cues simultaneously.

Systematic Use of Prompts

A prompt follows a cue and helps the individual understand the meaning of the social context and make the
correct response. Like cues, prompts can be social or environmental. This section highlights general types of
social and environmental prompts. The five general types of prompts, provided in a hierarchy from most to
least assistance, include
• Physical prompt: manual (e.g., hand over hand) support that guides the correct response
• Gestural prompt: gesture (e.g., pointing, touching) that guides the correct response
• Verbal prompt: auditory (e.g., spoken) direction that guides the correct response
• Modeling: demonstration of the correct response
• Environmental prompt: visual support that guides the person to the correct response
The selection of prompts is tied to the child’s core abilities, the child’s degree of rigidity or flexibility, and
the target social or communication skill. First, the selection of prompts depends on the presence or absence of
two core skills, the ability to share attention, and the ability to imitate:
• If the child demonstrates shared attention and imitation, use modeling paired with visual environmental
prompts as needed.
• If the child does not demonstrate shared attention and imitation, use physical, gestural, or verbal prompts
paired with visual environmental prompts as needed.
Second, the selection of prompts must take into account the tendency toward instructional prompt
dependency in some students with autism. Prompt dependency is a common instructional outcome, defined as
the ability to demonstrate a learned skill only under a single set of conditions: setting, activity, cues, and
prompts (McClannahan, MacDuff, & Krantz, 2002). Nevertheless, children with autism vary in the degree to
which they make rigid associations among cues, prompts, and responses. As a result,
• Use prompts on an “as needed” basis and in conjunction with other EBPs, including time delay and
reinforcement (Cox, 2013; Neitzel & Wolery, 2009; Wong et al., 2013).
• Use the least intrusive prompt necessary for the child to perform the skill.
• Do not prompt in the exact same way every time after initial skill acquisition.

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• Minimize the use of verbal prompts in isolation. Always pair a verbal prompt with a gestural or visual
environmental prompt.
• Offer the child optimal support by fading prompts from the most assistive to the least assistive to ensure
success and to eliminate a pattern of routine errors and prompt dependency.
• Maximize the use of visual environmental prompts to fade reliance on social prompts.
Third, the selection of prompts depends on the desired response or skill to be acquired. The desired
response is either an action or a communication; that is, something that the child will do or say. It is far easier
to prompt nonverbal responses (i.e., what to do) in social situations than to prompt spoken verbal responses
(i.e., what to say). The ensuing lists provide recommendations for prompting nonverbal social skills and
communication through speech or an AAC system. If a child with autism needs a prompt for a nonverbal
social skill,
• Use the child’s visual attention to determine when to prompt (e.g., if assisting a child to play who stops
looking at the toys, stop the activity, say nothing, and wait for the child to focus again before continuing to
prompt)
• Limit the use of verbal prompting, because many children with autism develop the routinized behavior of
waiting for the verbal prompt before acting
• Provide enough prompts to ensure that the child does not make a mistake (e.g., if a child is playing with
playdough and begins to put it in his mouth, prompt the correct use of the material)
• Be aware of the effect that physical prompting may have on children with tactile sensitivities
• Give the child time to process (i.e., time delay) and respond to cues and prompts
• Replace social prompts with environmental prompts to decrease the child’s reliance on others
If a child with autism needs a prompt for communication,
• Maximize the use of verbal modeling or use of the specific communication system
• Limit the use of questions as verbal prompts
• Use physical, gestural, and/or verbal means to prompt the child’s use of the AAC system as needed
• Pair verbal prompts with nonverbal prompts so that the verbal prompting can be faded
Social prompts should be faded systematically to decrease reliance on others and to foster independence.
Prompt fading is most effective when the student is initially given support to ensure success and minimize
errors, with prompts being faded gradually from most to least amount of assistance. Given that the ultimate
goal is the use of spontaneous social skills and communication, it is important to fade the use of social
prompts and to maximize the use of visual environmental prompts. The following vignettes illustrate these
important considerations.

Alex has been learning to play with closed-ended manipulative toys. He is able to play with the toys in a purposeful
manner only when an adult is present to intermittently give verbal prompts to continue. In the absence of verbal
prompts, Alex begins throwing the toys. In order to fade the adult from the situation, a video was made of Alex’s
mother giving him verbal reminders while he played. This video modeling technique, with his mother saying messages
such as “You’re playing nice” and “Yeah, Alex!” was enough to gradually fade the adult’s presence. Soon, only the video
was used to help Alex play independently for 15 minutes without throwing toys.

Nathan plays a board game with a friend. He learned the game but still needs verbal prompts for each step of the game.
If an adult does not give him a verbal prompt, he will say the prompt to him or her (e.g., “Nathan, spin it”) and wait
for acknowledgment. For Nathan, the prompt is part of the sequence of events that occurs during the game, and he is
unable to continue until the verbal prompt is given. To resolve this prompt dependency, the adult started to pair the
verbal prompt with a hand-over-hand point to a color-coded list of game rules. The adult quickly faded the verbal
prompt and gradually faded pointing to the list. This fade resulted in Nathan’s using the list of game rules as a
reminder and allowed for independence when playing board games with his friend.

Karen was taught to initiate play with a peer through a sequence of verbal directions and verbal prompts. Her teacher
first says, “Karen, ask Sophia to play.” Then she uses the verbal prompt, “Say, ‘… do you want to play?’” Karen
imitates the sentence while standing next to her teacher and Sophia. Then, her teacher praises her by saying “Sophia

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likes you asking her to play.” However, Karen asks a peer to play only under these prompted conditions. When she is not
verbally prompted, Karen looks at her teacher and says, “Say, do you want to play.” Karen has learned the sequence of
instructions and prompts without understanding the meaning of the words or understanding the link between her
message and the outcome. To address her prompt dependency, the teacher changed her instruction and prompts. Now,
the teacher models how to use a nonverbal tap to get the peer’s attention. Then, the teacher stands behind Karen while
verbally modeling and pointing to a written cue card prompt that says, Wanna play? Karen directs the message to her
peer and is reinforced by the peer, who says, “Yeah” and takes Karen’s hand to go play. To fade the adult prompts and
increase Karen’s spontaneous communication, the verbal model is faded first, then the visual cue card is quickly faded,
and gradually the adult’s touch is faded until a peer becomes the natural cue for Karen to say, “Wanna play?”

Consequences
A consequence is an event, either environmental or social, that occurs in direct response to an individual’s
behavior. In traditional behaviorism, there is a strong reliance on using consequences in the form of tangible
or social reinforcers in response to an individual’s behavior. Examples include reinforcing the child’s correct
actions by presenting tangible reinforcement (e.g., food) or social reinforcement (e.g., “Good”). Tangible
reinforcers are not generally related to the child’s activity or to the meaning of the child’s communication
efforts. Research has demonstrated that reinforcement and differential reinforcement of alternative,
incompatible, or other behaviors are effective practices in the field of autism (Bogin & Sullivan, 2009;
Kucharczyk, 2013a; 2013b; Neitzel, 2009b; Wong et al., 2013). Differential reinforcement of other behaviors
is providing reinforcement for desired alternative, incompatible, or other social and communicative behaviors
while ignoring inappropriate behaviors.
When using consequences to support social and communication skills, it is essential to use natural
consequences as much as possible. Given that social and communicative behaviors are intimately linked to
social motivation and interest, motivation and meaning—not artificial responses—should drive social
behaviors. Increase the effectiveness of natural reinforcement using the following strategies:
• Creatively embed tangible motivators into the activity rather than using them as reinforcers for completing
the activity; for example, rather than rewarding a student with his favorite train after completing an art
project, include train stickers as part of the art project or create a train collage or color a picture of a train.
• Naturally link verbal reinforcement to what the child is doing; for example, instead of responding to the
child’s request for “more cookies” with the artificial response, “Good talking,” link the verbal praise to the
message: “Yes! More cookies! Yum.”
• Plan so the child’s mastery of the social activity becomes a natural reinforcer.

Organized Interactions
Some individuals with autism struggle to extract meaning from what others are saying, doing, and feeling.
There is sometimes a lack of congruence between their abilities and the demands of naturally occurring
interactions. Individuals with autism can experience confusion with the dynamic and unpredictable quality of
typical social interaction. The outcome is a fragmented understanding of social–communicative experiences
and the use of repetitive or context-specific social–communication skills. Understanding, respect, and
empathy for their struggles form the rationale for the next set of instructional strategies: organized
interactions.
Organized interactions provide structure and enhance understanding, engagement, and participation in
social activities. Interactions are organized when all the elements of explicit instruction are embedded within
all reciprocal interactions. These organized interactions are a natural means to compensate for the social and
communication challenges characteristic of autism. The following sections discuss five ways to organize
interactions:
• Understand communicative intent
• Establish reciprocal interaction routines
• Balance directive and facilitative interaction styles
• Modify interaction patterns
• Coach peers

Understand Communicative Intent Communicative intent is defined as the purpose of an individual’s

social–communicative behavior. Nonverbal behaviors (e.g., eye gaze, facial expression, gestures) as well as

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verbal behaviors (e.g., speech, signing) are used to communicate intent. On the other hand, communicative
function is defined as the actual effect that an individual’s verbal and nonverbal behaviors have on others and is
based on an interpretation of the individual’s intent and meaning. There usually is a clear relationship between
the communicative intent of a typically developing child and how his or her message is interpreted by others.
For instance, based on context and the nonverbal behaviors (e.g., pointing to the door) of a typically
developing toddler, an adult correctly interprets the message as a request to go somewhere. The intent of a
person’s nonverbal and verbal behaviors can be inferred when messages are directed to a person, the message is
relevant to the ongoing activity or social context, the person waits for a response, and the communication
partner reacts to the person’s message.
Interpreting the intent and function of the nonverbal and verbal behaviors of individuals with autism can
pose a unique challenge. Sometimes, their nonverbal and verbal behaviors serve a social–communicative
function; sometimes, they are not interactive. At times, their nonverbal behaviors and verbal messages
function as noninteractive, self-stimulatory repetitive behaviors or as a means to self-regulate. Even when the
person’s behaviors are intended to be communicative, there can be a discrepancy between what the person
with autism says and what he or she means. The nonverbal and verbal behaviors of individuals with autism are
often misinterpreted by others due to
• Differences in their use of nonverbal skills; specifically, difficulty with eye gaze, joint attention, and
combining nonverbal and verbal behaviors in a single message
• Differences in their use of verbal skills; specifically, immediate and delayed patterns of echolalia
• Differences in their social perceptions; specifically, misinterpretations of language and social meaning
• Restricted or repetitive patterns of behavior that serve communicative functions
• Challenging behaviors that serve communicative functions
The following vignettes illustrate the unique challenges associated with interpreting the intent behind
nonverbal and verbal behaviors in children with autism.

Andy’s nonverbal behaviors often are misinterpreted. For instance, he indicates his desire for food or objects by looking
at the item intently. When this staring is not interpreted by others as a request for the item, he begins to cry. Andy lacks
the repertoire of nonverbal skills needed to be readily understood; namely, the ability to use attention-getting gestures
or to shift eye gaze from the object to the adult to make his request.

Laura uses delayed echolalia for a variety of communicative functions, although her intent is easily misinterpreted.
Until her education team learned the intended meaning of her echolalic messages, Laura often was frustrated by her
inability to be understood by others. For example, Laura would say, “Chocolate milk today” to ask if she could get milk
at lunchtime, but her message was misinterpreted as a comment. If she did not get the desired response from adults, she
persisted with her question, and her frustration escalated into a tantrum. Laura also would say, “You’re okay” in an
upset voice to ask peers to go away. When her message was misinterpreted by her peers and they did not leave, she
would persist with the same message and ultimately yell at them.

Robin often makes interesting statements that are the result of associations she has formed between events seen in
movies and her own social experiences. For example, Robin says, “I’m going to get you, my pretty” (from The Wizard
of Oz) when she feels afraid. Without adults and peers who understand the intent of Robin’s messages, her language is
easily misinterpreted.

Eugene talks incessantly. He repeats segments from television commercials, books, and movies that are not linked to the
social situation, or he talks himself through his activities. At other times, his language is used for interaction with
others. He makes requests, shares interests, and expresses feelings. Eugene often uses the same phrase to regulate himself
and to interact with another person. For example, he might say, “Time to go home” (to himself) while organizing his
backpack to go home, and later he might say, “Time to go home” to an adult to indicate that he is ready to leave school.

Caitlyn has two challenging behaviors that others misinterpret. She has developed a repetitive behavior of making
faces in the mirror, which escalates into self-injurious behavior. She also stares at adults and makes faces, but whenever
her behavior is misinterpreted as social communication—and, thus, an adult imitates her—Caitlyn begins her self-
injurious behavior. Similarly, she has a repetitive behavior of reciting a section from her favorite book. Whenever an
adult attempts to join Caitlyn in her recitation, she begins to scream. In both of these situations, her intent is
noninteractive, so social responses create problems.

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To support a child’s social success, it is important to determine the communicative intent and function of
verbal behaviors. Judge intention by focusing on the social context and the child’s nonverbal behaviors and
affect before, during, and after conveying a message. A person’s verbal and nonverbal messages generally can
be inferred as serving a social–communicative function when two or more of the following qualities are
present:
• Eye gaze, body orientation, or gesture is directed to a person
• Behaviors/messages are relevant to the ongoing activity or conversation
• The individual waits for a response
• The individual persists when the message is misunderstood
The ability of others to determine the communicative intent and function of messages is largely dependent
on the child’s nonverbal social–communication skills. The presence or absence of these core nonverbal skills
determines the ease with which communicative intent and function can be inferred by others. These
nonverbal interaction skills are central to conveying one’s intent accurately to others.
Establish Reciprocal Social Interaction Routines Interactive routines between adults and children are the
framework within which language and communication are first acquired. A reciprocal social interaction
routine is an interaction pattern that follows a logical sequence and involves a predictable set of contextually
meaningful communicative exchanges shared between two individuals either verbally or nonverbally. Social
routines enable children to learn social and communication skills through organized, predictable, and socially
salient modeling. Through consistent experiences with a social routine, a child assigns meaning to the
language and communicative behaviors used within the interaction. As the child acquires an understanding of
the meaning of the social routine, he or she can anticipate and insert one or more communicative messages.
Once the child can participate in an established routine, expansion and flexibility are introduced into the
social interaction. This ongoing expansion (i.e., scaffolding) systematically builds meaningful social exchanges
between two individuals. Box 6.1 outlines the steps and strategies for building reciprocal social interaction
routines and expanding the routines through scaffolding.

Box 6.1. Steps to building reciprocal social interaction routines

1. Plan routine
• Focus on motivating contexts that require shared focus and turn taking.
• Establish a predictable pattern of messages.
• Organize messages so the child with autism can anticipate what to say or do.
2. Engage in routine
• Maintain close proximity.
• Establish joint attention.
• Repeat the same message at predictable times.
• Make nonverbal cues explicit.
• Simplify language complexity.
• Use time delay and give the child time to respond.
• Limit the number and variety of interactive turns.
• Use AAC supports, as needed.
3. Maintain reciprocity
• Respond to the child’s level of focused, purposeful behavior at the moment.
• Imitate, shape, and expand on the child’s successful initiations.
4. Scaffold
• Systematically add a new message when the child initiates any purposeful nonverbal or verbal
behavior during the interaction.
• Systematically modify familiar messages in the routine once the child understands and uses the
originally established interaction.
5. Ensure flexibility
• Balance directive and facilitative interaction styles.
• Balance adult-directed and child-directed interactions.

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 Basic Social Routines There are a number of considerations for the design and implementation of basic
social routines for children with autism:
• Select contexts that require shared focus and turn taking.
• Select contexts in which the child is motivated to communicate.
• Establish a pattern of verbal or nonverbal messages that predictably occurs at set times during the
interaction or activity.
• Organize messages so that what the partner says or does is equally appropriate for the child to say or do in
the same situation.
• Organize messages so that the child can link a message with a visual environmental prompt in order to
remember what to say or do in that specific situation.
• Repeat the same message at predictable times.
• Limit the number and variety of interactive turns.

Scaffolding Social routines are valuable because they provide a framework for systematically introducing
new elements to the social context. The most critical element in social routines is the ongoing process of
expansion. The child’s level of engagement is the primary criterion for determining when to expand the social
routine. Children are typically engaged when they are motivated and understand the purpose and meaning of
the social interaction. When an individual with autism does not understand the meaning behind the messages
and events in the situation, the interaction routine needs to be simplified.
Once the child with autism masters the basic routine—as reflected by increased participation and
spontaneity—familiar messages are modified and new messages are introduced. This process of scaffolding,
which links new information to familiar information and builds on existing successes in a meaningful way, is
central to supporting communication development. Methods of scaffolding include:
• Modifying familiar messages in the routine once the child understands and participates in the originally
established interaction
• Adding a new message to the routine once the child spontaneously engages in the originally established
interaction.
The following vignettes illustrate various scaffolding approaches. The first, involving Eddie, demonstrates
a nonverbal interactive routine. The vignette about Betsy exemplifies scaffolding a play behavior. Larry’s
vignette illustrates a sample verbal interactive routine. The final vignette shows how conversation was
scaffolded to assist in Garret’s communication development.

Eddie hides under blankets frequently. His mother played a four-step Peekaboo game with him that involved 1)
covering his head, 2) counting to five, 3) taking off the blanket, and 4) giving him a kiss. This pattern was established
until he initiated putting the blanket on and off on cue and shared kisses. Then his mother 1) put the blanket on her
head, 2) counted to five, 3) prompted him to take it off, and 4) kissed him when he took off the blanket. Soon the game
alternated back and forth from his mother putting the blanket on Eddie to him putting the blanket on her. Eddie
maintained the routine with his mother. Once this social routine was established, Eddie’s mother added another
element to the game: kissing different facial features. They shared this exchange, with Eddie gradually giving his
mother kisses on the nose, head, ear, and lips.

Betsy is learning to imitate play actions. Specifically, she is learning to imitate a sequence of related actions, one at a
time, using playdough: 1) Press the playdough, 2) use cookie cutters, and 3) roll the playdough back and forth. When
Betsy masters one step, her teacher adds a second and then a third. All of the actions that Betsy imitates are related in a
meaningful way. Play has become a logical sequence of imitated actions that carry meaning. This process contrasts
sharply with teaching an individual to imitate a sequence of unrelated single actions with materials out of context.

Larry and his mother were singing a song with puppets. When the song was finished, Larry and his mother took turns
putting the puppets in the box using set phrases. His mother said, “In goes the puppet” as she put one puppet in the box,
waved good-bye, and said, “Bye-bye.” Next, it was Larry’s turn. His mother prompted Larry through gestures to put
the other puppet in the box, to say, “In goes the puppet,” to wave, and to say, “Bye-bye.” Larry’s mother then took
another turn. Next, she prompted Larry to say “In goes the ________” and put the puppet in the box. Larry looked at
her and said, “Puppet” and then imitated his mother waving and said, “Bye-bye.” After his mother took another turn,
Larry spontaneously tried to put the puppet in the box; his mother waited before waving, and Larry spontaneously

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smiled at his mother and said, “In goes the puppet; bye-bye.” Once this basic social routine was established, Larry’s
mother continued to add one new phrase at a time to the ever-expanding puppet game. The phrases were both linked to
their actions and arranged for systematic turn taking.

For Garret, shared reading time is an opportunity to engage in a conversation, composed of predictable turns, with his
teacher. They each take turns describing a page of a book. Garret’s teacher describes the first page, Garret describes the
next page, and so forth. The complexity and variety of comments are linked to Garret’s current language repertoire,
and attempts are made to build new commenting functions into this repertoire. This process contrasts with teaching an
individual to answer a series of questions about a book by expecting him or her to give specific answers to questions
asked about each page. That technique encourages passivity and cue dependency, but Garret is learning to be
spontaneous and flexible through an interactive routine.

Balance Directive and Facilitative Interaction Styles The level of social and communicative behaviors in
children with autism varies significantly in response to different styles of interaction. Two primary types of
adult interaction styles are directive and facilitative. The characteristics and outcomes associated with each
style are compared in Table 6.2. When structuring interactions to aid in social and communicative
development, be sure to balance both styles of interaction.

Table 6.2. Comparison of directive and facilitative interaction styles

Interaction style Characteristics Outcomes
Directive Adult initiates interaction. Increases social predictability
Adult structures child’s response. Increases simple turn taking
Adult uses questions and directions. Increases responses to other’s initiations
Adult prompts target response.
Facilitative Child initiates interaction. Increases reciprocal interaction
Child leads direction of the interaction. Increases spontaneous communication
Adult partner uses imitation, elaborations, and expansions. Increases ability to maintain a conversation
Adult partner uses pausing and conversational lags.

Directive Style of Interaction A directive style is associated with a behavioral approach to adult–child
interaction. When using a directive style, the adult controls the focus and direction of the social interaction
and structures the child’s contributions to the ongoing interaction. The adult’s verbal interaction style is
dominated by the use of questions, directions, commands, and verbal prompts to elicit specific responses.
Nonverbal gestures or physical prompts are also used to elicit a specific response. Directive styles increase the
ability of a child with autism to be focused and organized; they also increase the social responsiveness of a
child who lacks imitation skills.
Facilitative Style of Interaction The facilitative style is associated with a developmental approach to adult–
child interaction. When a facilitative style is used, a child with autism controls the focus and direction of the
interaction and is encouraged to contribute to the interaction in a variety of ways. The adult’s interaction style
is dominated by conversation related to topics introduced by the child with autism; comments that
acknowledge or elaborate on the child’s nonverbal and verbal behaviors; and long, silent pause times.
Facilitative styles rely heavily on the child’s ability to engage in purposeful activity; therefore, they increase
social behaviors in children who have shared attention and imitation skills.
Both directive and facilitative styles have a noticeable effect on the social engagement of children with
autism. Directive and facilitative styles also influence the communication patterns of children with autism who
possess verbal abilities. In a facilitative style, adults support the conversation with comments and elaborations.
These techniques encourage more individual initiations than when conversation is directed through questions
(i.e., in a directive style). The following vignettes illustrate both interaction styles. The first vignette highlights
an adult and a child looking at a book together and exemplifies the directive style of conversation.

Adult: Who is it? (points).

Child: A boy.
Adult: Look—what is he doing?
Child: Blocks.
Adult: Say, “He’s building blocks.”
Child: He’s building blocks.
Adult: What color? (points).
Child: Red.

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Adult: Say, “Red blocks.”
Child: Red blocks.

In this next vignette, an adult and a child are engaged in the same activity, but the conversation occurs in a
facilitative style.

Adult: This is a boy, and (points)…

Child: This is a girl.
Adult: He’s building, and… (points).
Child: A doll.
Adult: Playing with the doll.
Child: A bottle.
Adult: Yes, eating; yum.
Child: Yum-yum.
Adult: (points)
Child: Blocks, 1-2-3-4-5.
Adult: Five blocks; he’s building.
Child: Building blocks, 1-2-3-4-5.

Combining Directive and Facilitative Styles: The Dance of Interaction Directive and facilitative interaction
styles represent the polarity of interaction possibilities, and the most reasonable approach is a combination of
both. The combined approach, called the dance of interaction (Quill, 1995), entails choosing when to be
directive and when to be facilitative based on the child’s nonverbal and verbal behaviors. Most children with
autism vary in the degree to which they are able to demonstrate social observation skills and imitation skills.
Answer the following two questions to help determine how to balance the use of directive and facilitative
styles:
• What are the child’s current core social–communicative abilities?
• Is the target objective to elicit a specific response or to facilitate spontaneous communication?
To determine the presence or absence of core nonverbal social interaction skills, which are central to
determining whether to use a directive versus facilitative style, answer the following questions:
• What are the child’s social observation skills at the moment?
• What level of joint attention is the child able to engage in at the moment?
• What is the child’s ability to imitate (e.g., acts or words) at the moment?
• What is the child’s level of organization (e.g., calm)?
Children with autism vary, moment to moment, in their ability to focus attention, observe, imitate, and/or
remain organized during a social interaction. Moment-to-moment abilities are also influenced by how easily
the child 1) becomes frustrated in loosely structured activities, 2) is confused by unanticipated social–
communicative messages, and 3) becomes uncomfortable in particular settings. Other contextual factors that
influence the child’s ability to remain focused and organized include unpredictable social contexts, confusing
transitions, difficult tasks, uncomfortable sensory stimuli, and situations that cause fear or anxiety. Remember
that a directive style can be useful when core skills are lacking and the child needs help becoming focused and
organized. On the other hand, when the child is engaged in an activity and is able to display focus and
attention, a facilitative style might be more appropriate, particularly if the goal is to facilitate more
spontaneous communication.
Determine whether the goal of the interaction is to elicit a specific response or to facilitate spontaneous
communication. The goal in many social situations is for the child to demonstrate a specific social behavior
such as playing a game with rules. Or, sometimes the goal of instructional settings is for the student to answer
a specific question. These goals lend themselves to a more directive style of interaction. The goal for many
social situations, however, is to demonstrate spontaneity and creativity within a social context, and the primary

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goal of communication enhancement is to foster spontaneous communication. Nonverbal and verbal
communication is considered to be spontaneous when
• Messages occur without any specific contextual or social cues (e.g., naming an object or event without
explicit cues)
• Messages occur in response to specific contextual cues (e.g., labeling a picture in a book during shared
reading)
• Messages occur in the presence of a delay in conversation (e.g., changing the topic)
• Messages occur in the absence of specific instructional prompts
Some further guidelines for deciding on whether to use a directive or facilitative interaction style are as
follows:
• If the goal is to enhance the child’s ability to engage in simple turn taking involving questions and answers
and increase responses to other’s initiatives, use a directive style.
• If the target goal is a specific response, use a more directive approach.
• If a child is disorganized or lacking shared attention and/or motor or verbal imitation skills at the moment,
use a directive approach.
• If the goal is to use conversation as a means to foster reciprocal social interaction, use a verbal directive
approach and infrequently ask questions.
• If the goal is to have the child be an active responder, do not use questions, because they can close or end
an interaction and place the child in the role of a passive responder.
• If a child is focused, sharing attention, and/or displaying motor or verbal imitation skills at the moment,
use a facilitative approach.
• If the goal is to foster a child’s spontaneous communication and his or her ability to maintain more
elaborate conversation exchanges, use a facilitative style.
Spontaneity, which is essential to socioemotional regulation and communicative competence, is a desired
end goal when teaching social and communication skills. Facilitative techniques elicit more spontaneous
interactions and should be used at every opportunity for spontaneous communication.
The dance of interaction requires an understanding of each child’s idiosyncratic interaction style as well as
a willingness to be flexible. In particular, it also necessitates that adults
• Balance adult-directed and child-directed interactions
• Respond to the child’s level of focused, purposeful behavior at the moment
• Modify the child’s unsuccessful initiations
• Shape the child’s partially successful initiations
• Imitate and expand on the child’s successful initiations
Although this style of interaction is complex and dynamic, the adult can generally make one of three
choices:
1. Direct the interaction of the moment.
2. Address the child’s unsuccessful attempts by redirecting the interaction of the moment.
3. Follow the child’s successes of the moment through imitation and scaffolding.
It is important to remember not to follow the child’s lead when he or she is engaged in nonverbal or verbal
inappropriate behaviors. Always teach meaningful prosocial and communication replacement behaviors. The
following vignettes illustrate these guidelines involving both nonverbal and verbal interactions. In the first
vignette, a child who is nonverbal and an adult are next to each other at the sandbox. This example
demonstrates a nonverbal dance of interaction.

Child: Sifts sand through his fingers

Adult: Physically prompts scooping
Child: Scoops sand

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Adult: Fades prompt, mirrors the child’s action using another shovel
Child: Scoops sand
Adult: Scoops sand and says, “In the bucket” and repeats multiple times
Child: Drops the shovel and pats the sand
Adult: Pats the sand and says, “Pat, pat, pat”
Child: Sifts sand through his fingers
Adult: Prompts scooping again

This next vignette demonstrates the dance of interaction during conversation. A child and an adult are
looking at a picture book. The adult balances direct questions with facilitative comments and silently points at
items in the book to cue the child to share additional information. This child is verbal, so a conversation
ensues.

Adult: What are the people doing?

Child: Playing
Adult: Playing with trains (points)
Child: Playing with dolls
Adult: Playing with puzzles (points)
Child: Playing with blocks
Adult: Building with blocks
Child: (loses focus)
Adult: Look.
Child: (looks at picture)
Adult: What color is this?
Child: Blue
Adult: This is a blue block. (points)
Child: A green block
Adult: This block is red. (points)
Child: Red

Modify Interaction Patterns Successful interactions require ongoing, moment-to-moment adjustments.

Adults continuously fine tune their interaction patterns in order to be understood by and to elicit information
from children. For children with autism, it is largely the responsibility of adults (and peers given adult
guidance) to adapt their styles of interaction to improve and maintain social–communicative exchanges,
continually modifying their interaction patterns in response to the child’s behaviors and response patterns.
Modified interaction patterns include syntactic simplicity, redundancy, and exaggerated nonverbal cues as well
as references to objects, activities, and events in the immediate environment. By modifying interaction
patterns in such a way, adults can increase the child’s understanding and use of language and enhance
participation in the social dynamics. Box 6.2 summarizes ways to modify reciprocal interactions.

Box 6.2. Ways to modify interaction patterns

• Maintain close proximity to the child.
• Establish shared attention.
• Simplify language complexity.
• Provide a means of communication—use AAC supports, as needed.
• Make nonverbal cues explicit.
• Use time delay and give time to respond.
• Use rhythmic language when appropriate.

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 • Act as an interpreter for others.

Maintain Close Proximity The most effective interactions occur when one is near a child with autism.
Position yourself at the child’s eye level. If an individual startles easily, approach slowly and observe behavior
for a moment in silence before conveying a message.
Establish Joint Attention Assume that a child with autism is doing the best he or she can to establish joint
attention at the moment, and then help. Consider the following when assisting the individual with joint
attention:
• If the child is not attending to an object, activity, or situation, determine whether he or she is distracted or
does not understand the events occurring at the moment.
• If the child does not understand the meaning behind the messages and events in the situation, clarify or
simplify information.
Remember that it is significantly easier to share attention when a concrete referent is available. Also keep
in mind that shared attention to the person, object, or action is more important than a vacuous eye gaze. To
establish joint attention
• Silently point to a concrete referent
• Take the child’s finger and point to the referent (i.e., physical prompting)
• Place a salient cue (e.g., a ribbon) on the finger used for pointing
• Use a predictable phrase to gain the child’s attention (e.g., “name”)
• Touch the child gently and wait

Simplify Language Complexity The complexity of adults’ language can affect the language and
communication performance of children with autism. Complex language can cause patterns of echolalia when
the child does not understand part or all of the message. Language complexity therefore needs to reflect the
comprehension abilities of the individual. Using familiar messages in familiar activities increases appropriate
interactions. Consider the following strategies for adjusting language complexity:
• If the child has processing challenges, use simple, activity-related language to aid comprehension.
• If the goal is to enhance comprehension, pair language with concrete referents.
• If the child needs assistance in understanding information regarding past and future events, use objects,
photos, pictures, or written information.
Information presented in grammatically simple sentences elicits better responses than complex sentence
forms. In addition, questions posed in sentence-completion form may draw out better responses than wh-
(i.e., who, what, where, when, why) and yes/no questions. For example, the fill-in-the-blank question, “The cat
is where?” is more likely to produce a correct response than the standard form, “Where is the cat?” Simplified
language involves
• Simple sentences rather than complex grammatical forms
• Grammatically correct phrases or sentences
• Concrete language
• Language linked to ongoing activity
• Familiar phrases used in similar situations
• Information paired with concrete referents

Use Augmentative and Alternative Communication Supports A language system must mirror the
communication and language system used by the individual with autism. Consider the following
recommendations for adopting a means of communication:
• If the individual uses gestural communication, make nonverbal gestural cues the most salient aspect of the
interaction.
• If the individual uses speech, pair spoken language with multiple nonverbal cues to enhance understanding

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 and use of speech.
• If the individual uses sign language, use total communication (i.e., signing plus speech).
• If the individual uses a communication board or other aided communication device, model use of the
communication system all of the time.

Make Nonverbal Cues Explicit The adult’s role is to make all of the subtle elements of conversation more
explicit. Nonverbal elements of conversation include tone of voice, facial expression, gesture, affect, and pace.
Recommendations for making nonverbal cues explicit include the following:
• If the goal is for the child with autism to extract meaning from the interaction, make the nonverbal
components of conversation salient to clarify the verbal message and increase the likelihood of
comprehension.
• If the child with autism responds to dramatic personalities, use drama and exaggerate when
communicating and interacting.
• If the child responds best to calm personalities, speak slowly, calmly, and in a highly predictable manner.
Whether the child with autism responds to dramatic or calm interaction styles, the nonverbal aspects of
communication are key elements for aiding comprehension. Overall, the explicit nonverbal features may
include
• An exaggerated slow pace or a fast pace
• A melodic tone of voice
• Dramatic facial expressions
• Exaggerated gestures
• Animation
• Sound effects
• Nonverbal facial expressions and gestures fixed in space and time
• Use of pauses
Give Time to Respond During social interaction, a child with autism often struggles to integrate the social
context, social cues, and meaning behind verbal and nonverbal messages. It is therefore important to give him
or her ample time to comprehend the communicated information and formulate a response. Consider the
following strategies for using time delay (Fleury, 2013b;. Neitzel, 2009d; Wong et al., 2013) and allowing
time to respond:
• If the goal is to help the child with autism make sense of a message, use time delay and pause after
delivering the message.
• If the child needs time to process and organize information, delay an immediate attempt to engage the
child after the initial communication. Do not attempt to deliver multiple repetitions of a message,
especially when paraphrased, because this can be overwhelming and confusing for an individual with
autism.
• If the goal is for the child to initiate an exchange, provide silent pauses within a conversation.

Use Rhythmic Language Interactions that involve rhythmic language and repetition help many children
with autism to participate in social interaction. Rhythmic language includes counting, reciting, and music and
can be used in many ways.
• If the child needs to calm down and refocus, sing a familiar song or repeat a familiar message each time he
or she appears anxious.
• If the child does not like to engage in a nonpreferred activity, sing a song to mark the length of the activity
(e.g., sing while the child is brushing his or her teeth).
• If the child needs help with transitions, count to 10 to indicate the amount of time left to complete a task.

Coach Peer Interactions The use of peers has been shown to make a difference in the frequency and
complexity of social and communicative interactions between children with autism as compared to adults (e.g.,

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Carter, Cushing, Clark, & Kennedy, 2005; Garfinkle & Schwartz, 2002; Lee, Odom, Loftin, 2007; Neitzel,
2008; Owen-DeSchryver, Carr, Cale, & Blakeley-Smith, 2008). Children with autism tend to initiate less
often, and their interactions are more routinized. Low rates of peer interaction and spontaneous
communication are especially apparent in unstructured, natural contexts. As emphasized previously, the
predictability of an adult’s interactions allows for increased communicative effectiveness in children with
autism, as compared with peers, who are less likely to adapt to their communication style. Therefore,
intervention to enhance the development of peer relationships includes both 1) peer-mediated instruction (i.e.,
coaching peers) and 2) modeling procedures (i.e., shadowing the child with autism). Peer-mediated support
strategies involve adults preparing peers to promote social and communication skills in a child with autism,
thus increasing rates of peer interaction.
Coach Peers Peer-mediated interventions increase interactions between children with autism and their
peers. These peer coaching strategies focus on helping the peer understand the child’s communicative
attempts and teaching the peer to initiate, respond, and maintain an interaction with the child with autism. It
is important to train the peer on the particular characteristics and needs of a given child with autism and to
teach peers how to react to possible challenging behaviors. That training should include the following key
points:
• Encourage peers to initiate and persist in establishing interactions with children with autism.
• Teach peers how to get the child’s attention and maintain an interaction.
• Model activities and coach peers through role-playing sessions prior to peer-to-peer activities.
• Provide opportunities for peers to practice what to do, such as to stand close, point to, or share an item.
• Teach peers what to say, with a focus on talking about their own actions, commenting on the actions of
the child with autism, repeating themselves, repeating what their peer with autism says, and requesting
clarification.
• Show peers how to persist if the child with autism does not respond, how to wait for a response, and how
to ignore certain behaviors.
• If a peer receives little feedback from the child with autism, provide ongoing reinforcement for the peer’s
efforts.
The range and complexity of peer instruction are contingent on the targeted social and communication
goals for the child with autism. The ultimate goal is to promote social–communicative interactions that are
mutually enjoyable and beneficial for all.
Shadow Child with Autism and Provide Modeling Another method to facilitate peer interactions is to
model interactions with peers and prompt the child with autism. When modeling for the individual, it is
important to make the role of the adult explicitly clear so that the child with autism understands with whom
to interact. For example, if the adult is face to face with the child with autism and prompts the child to direct
a message to a peer, then he or she might repeat the message to the adult and not to the peer. On the other
hand, if the adult stands behind the child, uses an explicit nonverbal cue that indicates “I will help you,” and
verbally prompts the child to direct a message to a peer, then the child is more likely to understand to whom
to direct the message. The following vignette illustrates this important distinction:

Jacob is playing with trains while his teacher sits across from him. A peer arrives at the train area to play. The peer
picks up one of the trains, so Jacob yells. The teacher says, “Jacob, say, ‘That’s mine.’” Jacob looks at his teacher and says,
“That’s mine.” His teacher points to the peer and says, “Jacob, look.” Jacob looks at the train that his peer is holding.
The teacher verbally prompts, “Say, ‘That’s mine.’” Jacob looks back at his teacher and says, “That’s mine.” This
exchange does not result in the peer’s giving the train back to Jacob and is not an effective means to support the peer–
child interaction.

A few days later, Jacob is again playing with trains, and his teacher is sitting across from him as before. Jacob yells
when one of his peers comes to the train area and picks up one of the trains. His teacher stands up and walks behind
Jacob. She places her hand on his shoulder and points to the peer. Jacob looks toward his peer. Next, the teacher says,
“That’s mine” and physically prompts Jacob to hold out his hand. Jacob holds out his hand to the peer and says, “That’s
mine.” The peer then gives Jacob the train. By shadowing Jacob from behind and using explicit prompts, the teacher
this time successfully facilitates the peer–child interaction.

For the child with autism who has more language skills, an adult can use modeling and provide assistance in

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interpreting peer behavior, which can help the individual better understand the social–communicative
behaviors of peers and expand his or her communicative repertoire. Examples include
• Pointing out a peer’s social behavior (e.g., “Mary’s confused because she doesn’t understand the math
problem.”)
• Prompting how to respond to peers’ behavior (e.g., “John didn’t hear you; you can tell him again.”)
• Encouraging perspective taking (e.g., “Joe is making a face because he doesn’t like that.”)
• Acknowledging feelings (e.g., “You are angry because Matt took the ball; tell Matt ______.”)
• Pointing out feelings in peers (e.g., “Debbie is crying because her knee hurts.”)
• Prompting how to respond to peers’ feelings (e.g., “Mike is afraid. Get a toy for him and maybe he will feel
better.”)
All of the social supports described in this chapter serve as a means to structure and enhance
understanding, engagement, and participation in social–communicative interactions. Social modifications are
a natural means to compensate for the social and communication challenges of children with autism.
Nonetheless, even when the physical environment is organized and the social environment is adapted, some
children with autism require additional prompts and cues to acquire social competence.

SUMMARY
Building social and communication skills in students with autism is a process that begins with identifying
opportunities to teach skills, which involves carefully selecting and arranging the social contexts, settings, and
activities in which skills will be taught in order to maximize learning. Remember that every moment is a
potential teaching opportunity to build skills. Teaching these social and communication skills requires explicit
instruction on specific goals and objectives and involves structuring social interactions so as to compensate for
social and communication challenges and support success. At the same time, it is important to acknowledge
the social and communication efforts an individual makes and to develop an acute sensitivity regarding the
effect that adult and peer behaviors have on the child’s social and communication development. A positive
emotional experience is the ultimate motivator for social and communication success.
Respect for the social, communication, and behavioral challenges characteristic of autism necessitates the
use of numerous specialized supports. The next chapter discusses the combined use of organizational, social,
and communication supports to further enhance the development of social understanding, social skills, and
social–communicative interactions in children with autism.

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 CHAPTER 7

Instructional Supports to Enhance Social and

Communication Skills

LEARNING GOALS:
1. Learn how to use instructional and behavioral supports to enhance social and communication skills and
meet the needs of students with autism.
• Describe the importance of using organizational, social, communication, and behavioral supports to
enhance social and communication development.
• Describe the decision-making process to address restricted and repetitive behavior in children and
youth with autism.

C hildren and youth with autism are confronted with a world of social confusion, communication
difficulties, and sensory sensitivities. This is compounded by their inherent drive for repetitive
behaviors and feelings of anxiety. Approaches to instruction and intervention must therefore be
based on an understanding of the student’s challenges and should consider the use of compensatory supports.
The rationale for these compensatory supports is based on a respect for the social and communication
struggles experienced by individuals with autism. Instructional accommodations and supports can provide
social bridges for the individual and maximize opportunities for organizational and social–communication
success.
Most of the key instructional supports to facilitate learning discussed in this chapter are antecedent based,
meaning that they are accommodations and arrangements to events that can be set up in advance to prevent
problems, ensure the child’s success, and reduce the likelihood of challenging behavior from occurring.
Antecedent-based interventions (ABI) include a variety of modifications in the environment that are made in
an attempt to change or shape behavior (Hume, 2013a; Neitzel, 2009a; Wong et al., 2013). This chapter also
discusses planning intervention for the complex restricted and repetitive behaviors associated with autism.
When a child’s challenging behaviors pose an obstacle to learning and social functioning, increased
understanding of these complex behaviors becomes essential to all aspects of intervention planning.
The level of support required in the natural environment will vary according to the specific social and
behavioral needs of each student with autism. Using the principles of UDL, many educators proactively plan
and create environments with embedded supports (e.g., predictable classroom routines, visual charts,
schedules) to ensure that all students within a classroom have access to the learning and the support they need
to succeed. Although some supports are provided naturally through UDL principles, at other times the
environment may need to be modified more explicitly through ABI (e.g., student’s own activity schedule,
headsets provided to reduce noise level). Instructional supports should compensate for social and
communication challenges, support the development of social and communication skills, and eliminate
triggers for challenging behavior. The four types of accommodations and supports discussed in this chapter
are
• Organizational supports: When a student with autism struggles with transitions or understanding language
and social meaning, organizational supports provide more structure and clarity. Organizational supports
might include physical arrangement of the environment, clear visual boundaries and labels, activity

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 schedules, and alternate seating arrangements.
• Social supports: When a student demonstrates challenges with social skills, social understanding, or social
interaction, social supports can assist with social comprehension and the acquisition of social skills.
Supports to modify and/or clarify the social environment might include scripts, social narratives, and video
modeling.
• Communication supports: When a student demonstrates challenges with speech, language, or
communication in one or more contexts, communication supports can assist with language comprehension
and the acquisition of communication skills. Supports to modify and/or clarify social communication
might include visuals, communication boards, conversation books, and other AAC systems.
• Behavioral supports: When a child engages in restricted and repetitive behaviors in one or more contexts,
behavioral supports can help reduce challenging behaviors. Behavioral supports can be part of a plan to
modify and/or reduce restricted and/or repetitive behaviors that are due to poor inhibition associated with
a medical disorder, anxiety, impaired sensory regulation, or impaired social cognition.

ORGANIZATIONAL SUPPORTS
Organizational supports can compensate for difficulties understanding social and communication
expectations. The physical and social environments contrast sharply (see Table 7.1), which, in part, helps us
appreciate why individuals with autism are so easily overwhelmed and confused by the “social world.” The
learning preferences associated with autism often mirror the qualities of the physical world. Unlike social
events, the physical environment is predictable and organized. The physical environment is concrete and, as
such, generally allows the person with autism to focus attention on details or take as long as needed to
examine the physical elements. Because many children with autism focus on physical details to make sense of
their environment, one logical way to support their understanding of and success in the social world is to
provide an organized environment that compensates for the executive functioning challenges sometimes
associated with autism.

Table 7.1. Physical versus social environments

Physical environment Social environment
Concrete Abstract
Organized Unorganized
Predictable Unpredictable
Ordered Flexible
Patterned Random
Static—stays the same Dynamic—changes

The necessity for using organizational supports is determined by the characteristics of the child with
autism. Table 7.2 contrasts the characteristics of organized and disorganized individuals. Children with
autism who meet the criteria for being disorganized in a specific context could likely benefit from
organizational supports.

Table 7.2. Organized versus disorganized individual

The organized individual The disorganized individual
Is calm when alone Is overly active or extremely passive
Sustains purposeful attention to an activity Is distractible
Intermittently observes others’ behaviors Lacks social-observation skills
Initiates contact with others to interact Uses unconventional means to interact
Demonstrates communicative intent Engages in restricted and/or repetitive behaviors and interactions
Makes changes when directed Engages in challenging behaviors

Although there may be some children with autism whose challenges are so complex that they are
disorganized most of the time, it is important to remember that the ability to be calm and alert, observe
others, sustain attention, communicate with intent, and make changes varies within and across individuals.
Most individuals with autism are organized some of the time and disorganized at other times, and they will
likely demonstrate some level of internal organization in some settings and not in others. A person’s level of
organized behavior typically correlates with level of comfort, an understanding of the social events, and an
understanding of what to do in a given situation. That is, when an experience is structured and/or meaningful,
an individual is more likely to behave in an organized manner. In contrast, when an event is experienced as
unstructured, chaotic, overwhelming, or uncomfortable, an individual is more likely to behave in a
disorganized manner. The following vignettes illustrate how organizational levels can vary based on multiple
factors.

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During unstructured activities, Perry runs around his classroom—which is full of exciting materials and peers. During
structured activities, he is calm and focused and watches his peers. Perry’s level of organization varies with the
activity’s level of organization.

Adam begins each school day by straightening all of the books, papers, and materials in his classroom. He focuses on his
academic work and interacts with his peers until distracted by what he refers to as “a mess.” Messes included losing one
of his pencils or markers, a change in his schedule, or missing an opportunity to share during morning meeting. All of
these messes create disorganization for him and result in his inability to have calm, focused interactions with others.

Both of these students demonstrate varying degrees of organization, illustrating that the use of
organizational supports should likewise vary across settings and activities based on the child’s level of
organization at the moment.

Organize the Environment and Physical Setting

Individuals with autism naturally focus on details in their physical environment in order to know exactly
where to be and what to do in a particular social situation. Therefore, it is first important to establish
organization within the physical environment to provide students with an understanding of the expectations
and opportunities within the setting. The information in this section is based on structured teaching, which is
a set of principles and teaching techniques developed at the University of North Carolina–Chapel Hill
(Mesibov & Shea, 2010; Mesibov, Shea, & Schopler, 2005). The essential elements of structured teaching are
as follows: 1) structure the environment in ways that are understandable, 2) use relative strengths in visual
skills to supplement weaker skills, 3) use special interests to engage students, and 4) support self-initiated
meaningful communication.
Physical structure is a foundation of structured teaching. Physical structure refers to the way each area in
the environment (e.g., classroom) is set up and where materials are placed. For example, a physically
structured classroom setting provides organization and helps the students, staff, and visitors understand what
activities are occurring in each area at any given time. If a student with autism has difficulty understanding his
or her environment, provide a structured setting so that he or she can stay organized and demonstrate on-task
behaviors.
One purpose of organizing the physical environment is to diffuse the behaviors that occur when the child
with autism experiences sensory sensitivities. Every aspect of the physical environment should be organized in
order to minimize sensory challenges (e.g., auditory, visual, tactile) and distractions. Sensory strategies include
providing noise-reducing headphones, strategically placing the student’s desk to reduce visual distractions, and
using cushioned seats for increased comfort.
Another purpose of organizing the physical environment is to clarify expectations and decrease the child’s
need to rely on social information to make decisions. Strategies include 1) labeling clear physical and/or visual
boundaries in the environment; and 2) creating rules, procedures, and routines to clarify what is expected
within the physical space.
Establish Boundaries and Label Areas Clearly labeling areas of the classroom helps provide information
on what occurs in each space and establishes clear boundaries. Use bookshelves, partitions, or something as
simple as tape on the floor to create areas for each activity to occur. Structuring the environment for the
student with autism includes providing information that answers the questions who, what, when, where, and
how. These aspects of organization can be embedded in all social activities. Organizational supports are used
in the physical environment with the following goals in mind:
• Clarify expectations
• Increase attention to relevant details
• Increase purposeful activity
• Increase independence
• Increase ability to observe others
• Increase social interaction
• Enable the child to anticipate changes and make changes flexibly

Establish Rules, Procedures, and Routines After clearly creating and labeling physical spaces, teach the
child the activities that occur within each area along with the rules and expected procedures for each space.

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These rules and procedures for each area then become powerful routines and cues for expected behavior. Each
classroom should display a visual list of rules that outlines desirable prosocial expectations. Putting rules in
visual form ensures clear and consistent expectations and gives students something to refer to. A
sociobehavioral display can refocus attention and provide a concise and simple cue or prompt when the child
exhibits undesirable behaviors. Displays that depict rules can be presented in picture, pictographic, and/or
written form. Rules should be based on the principles of PBS and should state the expected behavior. They
can be used alone or in combination with other behavior management procedures. Visual displays (e.g.,
posters, bulletin boards) should
• Clearly specify the desired behavior
• State a manageable number of rules (e.g., approximately three to five)
• State positive rules in clear, concrete, concise, and observable terms
The following vignette illustrates an example of an effective visual display.

Billy has difficulty sharing toys with his peers. He yells and grabs toys often during social play activities. Therefore, a
pictographic and written display was created for Billy that lists the rules: 1) use a quiet voice and 2) take turns with
toys. Billy reviews the rules daily and practices sharing with adults. This display is in the play area, and it is used by
adults and peers to cue and prompt Billy.

Organize Environment to Support Social Skills The following sections provide more concrete examples for
how the physical environment can be organized to increase social skills, specifically in the areas of 1) solitary
play and leisure, 2) social play and leisure, 3) group participation, and 4) community social skills. There are a
variety of ways to organize the environment to promote focus, attention, and engagement in social skill
activities for students with autism.
Provide supports to assist the student in understanding aspects of activities such as 1) where to be, 2) what
materials to use, 3) what to do, 4) with whom to interact, 5) for how long to engage in the activity, and 6)
when the activity is done. Students also should be taught how to make changes flexibly. These aspects of
organization should be embedded in all social activities to increase purposeful play and leisure activity.
Participation can be enhanced by organizing space, materials, activities, social expectations, time, and
transitions.
With all activity types, start by organizing the space or location (e.g., table, rug, fenced yard) to answer the
question “Where should I be?” If a student has trouble staying in a space, create boundaries. For example, put
an X on the floor to designate where to stand or a mat on the floor to designate where to sit. Then, organize
the materials to be used to help answer questions such as What choices do I have?, What do I use?, and What do I
share? If the student with autism is easily overwhelmed, provide only the exact materials needed for a
particular activity or limit the number of choices to create more structure. Other ideas are to label materials
and provide checklists of activities.
Next, organize the activity expectations to help answer the question, What do I do? Provide a specific
number of containers in the designated area with activity materials or provide a list of things to do. Then,
organize the social expectations to help answer the question, With whom am I expected to interact? If the goal is
solitary activity, use a specific space to indicate that it is time to play alone.
All activities should include an organization of time that helps answers the question, How long am I
expected to do this? This can be accomplished through the use of a timer, music, or a finished product to
indicate length of expected activity time. Because change can be an area of challenge, organize transitions and
help answer the question, When am I done? Use a visual schedule or a familiar “transition song” or verbal
countdown (e.g., “10, 9, 8…”) to help prepare the child for a transition. Tables 7.3–7.6 focus on social
development and include a detailed look at strategies for helping children with autism to understand the who,
what, when, where, and how of participating in activities. Vignettes depicting how to implement strategies for
organizing the environment also are provided in each of the following sections.
Organize Environment to Support Solitary Play and Leisure If the goal is for the child with autism to
participate in solitary play and leisure activities, provide needed organizational supports to help him or her
understand what to do and how to engage with materials. The child also may need guidance on how to choose
preferred activities, remain engaged in solitary pursuits or independent work, follow a schedule, and transition
to new activities. As Table 7.3 indicates, visual and concrete cues and reminders can be very helpful to
organize learners with autism for solitary play and leisure.

Table 7.3. Organize the environment to support solitary play and leisure participation

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Organize environment Examples of strategies and supports
Organize location/space expectations: Where to be? Participate while sitting on a beanbag or a specific rug.
Participate in an area with boundaries marked by colored tape.
Participate outside within an area marked by flags or fencing.
Participate at the playground within visually marked boundaries.
Organize choices/material expectations: What to use? Limit the number of objects in one area.
Provide only the exact materials needed for a particular activity.
Place materials that go together for a single activity in individual transparent containers.
Label materials on shelves.
Provide a visual support checklist of activities that includes the maximum number of daily opportunities to engage with each item (e.g., videos =
one time, trains = two times, computer = three times, books = four times). The individual makes a selection and checks it off the list.
Organize routine/activity expectations: What to do? Provide a specific number of containers in the designated area.
Provide a specific number of materials for one activity (e.g., a container that contains playdough, four cookie cutters, a roller, and a display card
showing the steps for making playdough cookies).
Provide a list of activity options.
Organize social expectations: With whom? Place a photo of the child in the area to clarify that this is time alone, in contrast with showing the child photos of his or her peer partners
during other times of social play and leisure activities.
Use a specific space to indicate that it is time to play alone.
Organize schedule/time expectations: How long? Use a timer to indicate length of solitary play and leisure time.
Use music to indicate length of play and leisure time (i.e., when music stops, activity is finished).
Define completion of the activity by the number of material pieces (e.g., string together 20 beads).
Define completion of the activity by the finished product (e.g., complete a 50-piece puzzle).
Visually specify what to do when the materials do not clarify completion (e.g., put a sticker on each of the five pages to be completed in a
book).
Visually depict time using a duration time board. A Velcro strip of numbers or letters in the child’s name or a set of pictures that symbolizes the
activity is presented to the child, and items are added (or removed) one by one so the child can see the passage of time.
Visually depict the current and next activity using “First…then…” in picture or written form, especially when the next activity is highly
preferred.
Organize transition expectations: When done? What to do Include solitary play or leisure time on a daily visual schedule.
next? Select a particular location where the child puts completed projects.
Use a familiar transition song.
Use a verbal countdown to prepare for transition (e.g., “10, 9, 8…”).
Have the child bring the finished project to show and tell.
Provide the child with a visual reminder to communicate when done (e.g., “all done” card at the bottom of the time board).

The following vignette demonstrates how organizational supports help students with autism participate in
independent classroom activities and use materials appropriately.

Carla has difficulty completing independent work and staying in her designated work spaces in the classroom when she
is not motivated by the task (e.g., math, writing). Providing a checklist of what she is expected to complete in each area
has reduced her need for constant supervision and prompting. Carla is very interested in the art area because she loves
to draw pictures of animals. Carla’s teacher has provided her with a photo choice board that she uses to select and
sequence her choices of materials and activities. A first… then… schedule has been provided so that she understands
she will get time in the art area. Carla will take markers out of other areas with her to the art area. She prefers the
color blue and worries that there will not be a blue marker available when she gets to the art area. To address this
worry, the teacher has put separate colored markers in different clear bins so Carla can clearly see that there are enough
blue markers for everyone.

Organize Environment to Support Social Play and Leisure Many of the strategies for organizing the
environment to support solitary play and leisure should also apply to social contexts. Table 7.4 outlines some
organizational supports and strategies unique to social play and leisure. Organizational supports for social play
include visual or object cues that help the child with autism to interact with peers of his or her choice and
navigate important requirements of the leisure activity, including sharing materials, taking turns, and waiting.
When organizing social play and leisure, it also is helpful to build on the complexity and difficulty of play,
beginning with parallel activities for which the child has his or her own set of materials, or more structured
and predictable activities with a clear sequence or set of rules. Then, as the child learns to engage in these
activities, move on to support more interactive play.

Table 7.4. Organize the environment to support social play and leisure participation
Organize environment Examples of strategies and supports
Organize location/space expectations: Where to be? Apply the previous ideas for organizing space expectations for solitary play and leisure.
Limit the number of peers in a particular area (e.g., use hooks for students to place their name tags in an area).
Place the student’s name on his/her chair or provide a special mat.
Use colored tape to indicate where to stand or wait during a game.
Organize choices/material expectations: What to use? Apply the previous ideas for organizing material expectations for solitary play and leisure.
Select toys and activities that the child has mastered in solitary play and leisure.
Select play and leisure activities that have an equal amount of materials available for each individual.
Provide a box of objects that specifies activity choices and how many individuals can participate in each activity (e.g., a box containing four
paintbrushes for four individuals to select art, three small blocks for three individuals to select the block area, two bookmarks for two
individuals to select the book area, two hats for two individuals to select the dress-up area, four pieces of chalk for four individuals to write on
the concrete at recess).
Organize activities so that each child has his/her own set of materials.
Emphasize physical activities, structured games, or activities that allow parallel participation.
Select activities that are organized and predictable (e.g., projects or games with clear outcomes).
Have the child and his/her peers plan in advance what to use and what to share.
Provide spatial boundaries to indicate personal possessions versus shared possessions (e.g., use trays in the block area to clarify that the blocks
on the child’s tray belong to him, the blocks on each peer’s tray belong to that peer, and the blocks not on any tray can be shared) when
activities require sharing materials.
Group peers into play partners to limit the amount of sharing needed when activities require sharing materials.
Divide materials among the children in different colored containers (e.g., learner with autism always uses the items in the blue box).
Organize routine/activity expectations: What to do? Apply the previous ideas for organizing activity expectations for solitary play and leisure.
Use the previously listed physical organizers for space, choices, and possessions to facilitate sharing during social play.
Select activities that the child has mastered in solitary play.
Clarify whether the expectation is parallel play with own set of materials, parallel play with shared materials, or interactive play.
Select activities that allow for clear turn taking (e.g., putting together a train track with one peer) for interactive play.
Use cue cards to remind all children what to do and whom to watch.
Organize social expectations: With whom? Apply the previous ideas for organizing social expectations for solitary play and leisure.
Have the child with autism select partners before the play or leisure activity begins.
Have the child select one or more peer partners from an array of photos.

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 Limit the number of individuals permitted in a play or leisure area (e.g., place a limited number of chairs or mats in a particular area).
Organize schedule/time expectations: How long? Apply the previous ideas for organizing time expectations for solitary play and leisure.
If waiting is required in the social play and leisure activity, provide the child with an object to hold while waiting or a card that reminds him or
her to wait during the social activity.
Organize transition expectations: When done? What to do Apply the previous ideas for organizing transition expectations for solitary play and leisure.
next? At the end of the activity, have peer partner say goodbye to the child with autism to signify the transition to the next activity.

The following vignette illustrates how organizational supports can help students with autism learn to play
with peers over time.

Barry ran aimlessly around the room during free time in his classroom. He had a number of solitary play and leisure
interests at home, but he was unable to make independent choices, sustain attention, or interact with peers during free
time in school. Barry’s teacher set up two activity choice boards for him, one containing activity choices and the other
containing photos of his favorite classmates. At the beginning of free time, Barry selected two peers (who had the option
to agree or decline) and two social activities. Initially, the activities were manipulative materials or art projects that
allowed for parallel participation. The space, time, and materials were organized. Gradually, Barry and his peers
began doing activities that required sharing and turn taking. To organize sharing, Barry was given a box to hold
those things that he did not want his peers to touch and was reinforced for occasionally exchanging items in his box
with one of his peers’ toys. To organize turn taking, Barry was given a reminder card to wait for his turn. Clarifying
space, materials, partners, and expectations dramatically organized Barry to engage in social play and leisure
activities.

Organize the Environment to Support Group Participation Most of the examples and strategies for
organizing the environment to support solitary and social play and leisure apply to group contexts. Table 7.5
provides some considerations that are specific to group participation. Students with autism often need physical
organizers, nonverbal cues, and other concrete reminders or visuals to help them know what to do and who to
watch when in group settings, particularly in larger groups and as the group expectations or activity becomes
more complex. These organizational supports help the student with autism to maintain attention, navigate
social events, and participate effectively in a group.

Table 7.5. Organize the environment to support group participation

Organize environment Examples of strategies and supports
Organize location/space expectations: Where to be? Apply the previous ideas for organizing space expectations for solitary and social activities.
Have a designated location for all group activities.
Place a card with the child’s name at his or her location.
Place a taped “X” on the child’s place to stand in the group.
Have the child select a partner to sit or stand with during group activity.
Allow the child to be first or last if the activity involves taking places in a line.
Organize choices/material expectations: What to use? Apply the previous ideas for organizing material expectations for solitary and social activities.
Allow the student to hand out or collect group materials as often as possible.
Use different color-coded folders for each subject/activity area.
Provide color-coded index cards with lists of materials needed for each group activity.
Use color-coded folders and boxes for each subject’s or activity’s work and materials.
Organize routine/activity expectations: What to do? Apply the previous ideas for organizing activity expectations for solitary and social activities.
Make a list of the group rules (e.g., watch, wait, raise your hand, share, take turns, listen).
Cue child while in the group as needed.
Organize small groups (i.e., fewer than five) whenever waiting is required.
Position the child in the group to maximize his or her ability to observe others.
Target one peer for the child to watch in order to remember what to do.
Provide a visual cue to clarify who the child is expected to watch or listen to (e.g., a colorful stick is held by the adult or peer who is talking).
Provide a list or outline of the group’s sequence of activities.
Organize social expectations: With whom? Apply the previous ideas for organizing social expectations for solitary and social activities.
Minimize social confusion and random turn taking when possible.
Use an object or colored cue to designate multiple small groups (e.g., work at the red rug area).
Organize the sharing of ideas so that students take turns in a circle and the speaker holds something that signifies he or she is the speaker (e.g.,
a plastic microphone) in cooperative learning group activities.
Organize schedule/time expectations: How long? Apply the previous ideas for organizing time expectations for solitary and social activities.
Use more physical organizers as the group gets larger and group expectations become more complex.
Organize transition expectations: When done? What to do Apply the previous ideas for organizing transition expectations for solitary and social play and leisure.
next? Use nonverbal cues for group transitions (e.g., turn down lights, have all of the group members raise their hands).
If waiting is required during the group activity, provide students “wait” and “my turn” cards.
Set a timer to provide very clear wait times and to indicate the time elapsing before a transition.

The following vignette illustrates how supports can be used to help students with autism stay on-task
during group activities and become active participants.

Tammy participates in group activities during which everyone does the same thing at the same time, but she has
difficulty understanding the rules of turn taking and watching peers in group situations. Tammy understands the
information conveyed by language but is unable to follow the social events. In her classroom, she frequently blurts out
questions or comments; during free time, she wanders aimlessly. Several physical organizers are being used in the
classroom to assist Tammy: 1) the teacher writes down the main discussion ideas as the group is talking, 2) the teacher
has Tammy sit near her, 3) the teacher and the students hold a feather when they speak so that Tammy always knows
whom to watch, and 4) the teacher places a reminder card on the board that reads, Raise your hand. For outside, prior
to free-time activities, 1) peers help Tammy plan for organized games, and 2) Tammy makes a checklist of the
materials she needs to organize her activities. The checklist is meaningful because Tammy enjoys writing.

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 Organize Environment to Support Community Participation Physical settings in the community—a
relative’s house, doctor’s office, restaurant, bowling alley, movie theater, or museum—generally lack
organization and can therefore be very difficult for the child with autism. It is important to understand that
even with organization and planned intervention, the physical surroundings may remain chaotic from the
perspective of the child with autism and that organizing community environments can be challenging.
However, Table 7.6 presents some general guidelines and ideas that can be effective in helping an individual
with autism feel more organized and calm in community settings. Despite the challenges that are inherent in
community environments, which often are the most socially unpredictable settings, careful preparation and
planning can position the child with autism for successful participation in important community activities. A
major goal is to help the individual understand what to do in the specific community setting, how to navigate
that particular location or space, and what the expectations are in that community environment.

Table 7.6. Organize the environment to support community participation

Organize environment Examples of strategies and supports
Organize location/space expectations: Where to be? Apply the previous ideas for organizing space expectations for solitary, social, and group activities.
Preview community location and expectations in the environment to plan how to prepare the child for the environment.
Visit community location for a short period of time during the first visit and gradually build up to actual full-length visit. For example, go to the
doctor’s office, check in with receptionist and look at the fish tank in the lobby, and then leave. Gradually build up to the actual doctor visit.
Same strategy can be used for barber shop/hair salon.
Show a video or read a book to child highlighting the community setting in advance of the visit. Examples include “Going to the dentist’s
office” and “Visiting the zoo.”
Create a list of expectations and behaviors that would be appropriate and not appropriate for the community environment. For example, if
going to a community play, review the intermission schedule and read the part of the playbill that says no talking allowed. Teach that the
expectation is to be in the seat designated on your paid ticket.
Visit the community setting during a time when there is less traffic. For example, go to the grocery store when a favorite local sports team is on
television. Go bowling in the middle of the afternoon during the week.
Organize choices/material expectations: What to use? Apply the previous ideas for organizing material expectations for solitary, social, and group activities.
Organize community activities to assist the child in understanding what materials to use (and not to use) and what can be shared (and not
shared). For example, teach the child that an empty swing at the community park designates that it is available for use.
Organize routine/activity expectations: What to do? Apply the previous ideas for organizing activity expectations during solitary, social, and group activities.
Organize community activities to assist the child in understanding what to do. For example, if visiting the zoo or museum, follow a numbered
map to designate which thing to see first, second, and so forth. At the grocery store, have child acquire items on grocery list organized row by
row.
Organize social expectations: With whom? Apply the previous ideas for organizing social expectations for solitary, social, and group activities.
Organize community activities to assist the child in understanding with whom the activity is done and how to stay calm and focused. For
example, teach the child how to ask a person at the service desk where to find a grocery item.
Organize schedule/time expectations: How long? Apply the previous ideas for organizing time expectations for solitary, social, and group activities.
Organize community activities to assist the child in understanding how long the activity lasts. For example, when getting off the bus for a field
trip, announce the time the bus will be returning to the school. Set the student’s watch so that an alarm will go off to let him or her know
when to return to the bus.
Organize transition expectations: When done? What to do Apply the previous ideas for organizing transition expectations for solitary, social, and group play and leisure.
next? Organize community activities to assist the child in understanding when the activity is done and what to do next. For example, when shopping
for groceries, teach the child that the shopping is done when items are paid for. The next step is to go home and put away the groceries.

The following vignettes illustrate how to assist children with autism in navigating challenging community
activities with the help of supports that organize community experiences.

Toby is terrified of the doctor’s office and historically has required multiple adults to hold him for an examination. A
plan was generated to organize the experience for him. The emphasis was placed on the organizational elements of
what to do and for how long, how to stay calm, and when the visit would be done. To assist Toby in understanding
what to do, 1) video modeling was used, and a video was made about going to the doctor which Toby watched daily,
2) Toby practiced what to do by visiting the school nurse’s office each day, 3) Toby was given a special sticker book
linked to his special interest, and he places the stickers on a board one by one to mark the passage of time, 4) Toby’s
favorite music played while he practiced going to the doctor, and 5) a special high five was used to mark the end of the
event. His first visit consisted of a quick hello between Toby and his doctor, Toby using his sticker book in the waiting
room, and Toby and his mother leaving after they shared the special high five. Gradually, the procedure has evolved so
that now Toby can receive his physical examination without incident.

Shane demonstrates many social skills with peers in organized settings at home and school, but he has difficulty
maintaining self-control at parties. Shane had all of the individual skills of knowing what to do and how to share
materials during activities but was unable to use these skills in social contexts that included unfamiliar peers. A plan
was developed that focused on the organizational elements of where to be and with whom as well as how to stay calm.
The plan consisted of 1) Shane visiting the location of the party prior to the event and making a list of where he would
be for the different parts of the party, 2) Shane reviewing a list of peers who were attending the party, 3) Shane
picking two peers to interact with at the event, and 4) Shane selecting a quiet location where he could use his pocket
calculator for a few minutes when given a warning to calm himself. With these preparations in place, the next party
was a success for Shane and his peers.

Organize Schedules and Routines

Once the physical setting is organized, a second strategy to support social and communication skills is to
establish predictable schedules and routines and to communicate the sequence of activities and events.
Establishing a schedule and activity routines throughout the day is an essential aspect of intervention.

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Children with autism can experience difficulties with transitions, and these challenges can serve as obstacles to
independence. Schedules and routines can support individuals with autism with transitions, which are a large
part of any home, school, or work day. Schedules and activity routines consist of three consistent elements,
which are 1) a beginning, 2) a sequence of events, and 3) an ending.
The main function of visual schedules is to clarify the sequence of events and expectations. A visual
schedule can communicate event sequences through multiple forms of representation, including the use of
concrete objects, photographs, pictographs (e.g., symbols, icons), words, or a combination of these. Schedules
can specify 1) where to go, 2) what to do now, 3) what to do next, and 4) for how long. Schedules are typically
presented in linear order. Visual schedules are designed to match the needs of an individual and may vary in
length and form. This individualization is necessary because presenting too much or too little information on
a schedule can cause anxiety. Some schedules present one piece of information at a time, such as a first…
then… schedule, whereas other schedules may include the entire day’s activities. Some schedules provide
information in a horizontal left-to-right format, mirroring the way we read written text, whereas others use a
vertical top-to-bottom format. The location of the schedule is another consideration, along with how the
child will manipulate, interact with, and check the schedule. Some individuals use portable schedules that
travel with them, whereas other individuals have schedules located in a fixed location. Schedules can increase
independence in solitary and social activities. Sample schedules include
• Daily schedules (i.e., the sequence of daily activities)
• Transitional objects (i.e., a specific object linked to an activity to prepare the child for where to go)
• Activity or task lists (i.e., sequence of steps within a task or activity)
• Outlines or checklists of group discussions or a lesson
• Time boards or duration maps (i.e., a visual representation of time in sequence)
The following vignette illustrates an example of how schedules and routines can benefit students with
autism.

Billy requests a schedule, especially in new situations. He spends a lot of time checking his individualized daily schedule
during the school day. Although the schedule helps him to understand what comes next, he struggles with time concepts.
He has not mastered using a clock or telling time. His parents find time boards or duration maps a particularly useful
way to clarify time for him. Because Billy likes letters, his time board consists of a card that has the letters of his name
on a Velcro strip. As time passes, another letter is put on the card. When his name is complete, time is up, and he is
ready to go to the next activity.

For an individual with autism, routines are familiar or static activities in which he or she understands
explicitly what to do and for how long. Familiar routines assist the individual in two important ways:
• First, familiar routines allow the child to anticipate what is next, thereby increasing purposeful activity and
decreasing confusion.
• Second, familiar routines decrease the child’s reliance on another person providing a prompt.
Most social events and social interactions typically do not have a predictable sequence of events and often
do not have an obvious outcome. Thus, the inherent struggle for individuals with autism is that their desire
for routine and predictability conflicts with the dynamic and ever-changing aspects of social events and social
interaction. The difficulty with schedules and activity routines is that they have the potential to create rigidity
in individuals who are already driven to routines. Therefore, ensure that there is a plan for changes in
schedules and routines so the child with autism is able to remain calm and adjust. It is important to monitor
the child’s level of organized behavior across settings to determine when using predictable activity routines is
necessary.

SOCIAL SUPPORTS
A major challenge for individuals with autism is to extract meaning from what others are saying, doing, and
feeling. People with autism can experience confusion with dynamic and unpredictable social interaction, and
the outcome of this can be a fragmented understanding of social experiences. Understanding, respect, and
empathy for social struggles inform this second set of supports focused on socialization. Social supports are
defined as any accommodations as well as antecedent-based modifications that serve as a means to structure
and enhance understanding, engagement, and participation in social interaction. The sections that follow

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specifically focus on the use of visual supports to foster social understanding.

Visual Supports
Visual supports involve the use of visual information—actual objects, photographs, pictographs, written
language, or video—to preview and review social expectations and prepare, prompt, and support the child
with autism to meet these expectations and engage in successful social interaction (Quill, 1997). Visuals, an
EBP, are concrete, tangible referents that can support an individual’s ability to extract relevant language and
social and affective information from social situations (Hume, 2013b; Wong et al., 2013). Visual supports
assist individuals with autism to attend to social situations, remain organized, and understand social
expectations more readily. The rationale, uses, and benefits of visual supports are summarized in Table 7.7.

Table 7.7. Visual supports

Rationale Provide tangible, concrete information
Highlight relevant social information
Provide a concrete reminder of what to do or say
Decrease reliance on verbal and social prompts
Increase independence
Give the child access to information as needed
Allow for the fading of supports, with mastery
Ways to use Prepare (organize expectations)
Preview (teach skills prior to the social activity)
Prompt (provide instructional cues during a social activity)
Review (teach skills through review after the social activity)
Most beneficial when… The child is identified as a visual learner
The child is disorganized
The child demonstrates difficulty with verbal language
The child lacks joint attention skills
The child lacks imitation skills
Other strategies have not been successful

People with autism may be better able to attend to, process, and remember visuospatial material than
language or social material. Visual supports compensate for an individual’s difficulty integrating social
information and capitalize on possible strengths in processing visual information. Although children with
autism may sustain attention to graphic information in the same way as typically developing peers do, they
may be unable to shift attention quickly in order to gain meaning from transient social cues and language. As
a result of this difficulty with processing cues, visual supports are recommended in social contexts in which
verbal prompts have not been effective. Concrete visual cues highlight relevant social and language
information and, thus, can enhance a child’s attention to and understanding of social and language messages.
For instance, difficulty with spoken and modeled social interactions may be remedied with written
instructions.
Visual supports can build social skills and foster independence. Because visual supports provide children
with a concrete reminder of what to do or say, they decrease reliance on verbal and social prompts, thereby
increasing independence. Various forms of visual supports can be used in contexts in which a child has become
dependent on adult prompts and cues.
Visual supports also augment independence because they allow the child to gain access to cues as needed
and they can be faded with mastery. Several types of visual supports also play a role in skill development. For
example, acquisition, maintenance, and generalization of independent skills may increase with the use of
pictographic instructions, such as social narratives or stories, which may help many children with language and
reading competencies understand social situations. Video modeling is a highly motivating visual way to build
solitary play and leisure skills as well as other social skills.
Furthermore, using visual supports is an option in social contexts that create anxiety or challenging
behaviors in some children with autism. In these situations, the child is less likely to respond to verbal or
physical prompting. Concrete, tangible visual cues—which can be used alone or combined with other prompts
—provide clarification through indirect means as opposed to more direct adult prompts. Once the child feels
independent and comfortable in a particular social situation, he or she may naturally disregard the visual
support.
Visual supports are useful for children at most levels of cognitive development. It is recommended that
visual supports are used in the following ways to foster social interaction:
• Prepare the child for social activities by clearly outlining expectations.
• Preview and teach skills prior to a social activity.
• Prompt during instruction.
• Review a social situation after the activity is complete.
Prepare: Visual supports can outline and organize expectations. Daily schedules, displays of activity sequences,

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 and task lists can clarify expectations and social activities (Betz, Higbee, & Reagon, 2008; Cihak, 2011).
Visuals can decrease the need for the child with autism to make social judgments or to follow social cues
Preview: The majority of visual supports can be used as instructional tools for the student with autism before
he or she enters a social situation. Social scripts, social narratives or stories, video modeling, conversational
books, social encyclopedias, sociobehavioral displays, visual imagery, and relaxation techniques provide an
opportunity to learn about the relevant features of a social situation and to acquire social and
communication skills through preview and practice prior to the situation (Fleury, 2013a; Hume, 2013b;
Plavnick, 2013, Wong, 2013b; Wong et al., 2013). Given that social contexts often can be confusing for
children with autism, strategies that allow for preview may be more successful than strategies that are
implemented in context.
Prompt: Some visual cue strategies incorporate items that can be used as visual instructional prompts during
the social situation (Cox, 2013). The visual cues are presented or are available for the child to use as
reminders. For example, if a child with autism has difficulty staying on topic with a peer during a
conversation, the peer could point at a visual that reads, Stay on topic when the conversation goes off topic.
These nonverbal prompts are invaluable during social situations. If the child with autism has difficulty with
generalization of skills, prompts might be more successful than preview strategies.
Review: Visual supports provide the child with an opportunity to review the social expectations after an
activity is complete. The concrete, tangible cues allow for clarity and repetition of information. Students
with autism could use the same visual support that prompted the skills they were working on and self-
evaluate to determine whether they displayed the skills after performance. For example, after having a
conversation with a peer, a student with autism could reflect on whether he accomplished the following: 1)
greet peer, 2) make eye contact with peer, and 3) stay on topic during the conversation. A review is
especially important for reinforcing desired social behaviors, considering alternatives to inappropriate social
behaviors, and teaching replacement behaviors. There are many social decision-making strategies available
that allow a learner with autism to review a social situation. These include strategies such as social autopsies
(LaVoie, 2005) and Situations-Options-Choices-Consequences-Strategies-Simulation (SOCCSS; Myles,
Trautman, & Schelvan, 2004).

Types of Visual Supports This section provides brief descriptions of eight different types of visual
supports, providing their function and some real-world examples of how each type of support is used for
individuals with autism. The following guidelines contain some general ideas for how to arrange visual
instruction to meet the needs of children and youth with autism:
• If the child is having difficulty extracting meaning from verbal information, accompany verbal information
with visual supports.
• If the child appears disorganized and is not responsive to social prompts, consider visual supports.
• If the child lacks the core skills of joint attention and imitation and is less likely to respond to social
prompts, consider visual supports.
• If the child is at a presymbolic developmental level and does not show any interest in or ability to
understand information in picture form, use object cues because a basic level of symbolic understanding
may be necessary for other visual supports.
• If the child is interested in books or computers, teach the meaning of messages through photos or
pictographics because a learner who is able to match or sort photos or pictures also is more likely to benefit
from visual instruction than an individual who shows no understanding of graphic information.
• If the child shows an interest in videos or television, use video modeling.
• If the child has difficulty responding to verbal language instruction, visual supports should mirror his or
her level of oral language comprehension in content and complexity.
• If the child demonstrates interest in or understanding of written language, use strategies that use written
language instruction.
With the former tips and guidelines in mind, we will now consider the use of some specific types of visual
supports. Because there is a broad range of visual supports that aid in socialization, this section is limited to a
review of some the most common visual social supports used in intervention for children and adolescents with
autism. These include

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1. Activity schedules
2. Cue cards
3. Social scripts
4. Social narratives
5. Video modeling
6. Sociobehavioral displays
7. Self-regulation visuals
8. Relaxation cues
9. Social decision-making strategies

Activity Schedules The main function of visual activity schedules is to clarify the sequence of social events,
communicate social expectations, and increase independence in solitary and social activities. Examples were
provided earlier in this chapter under the section, “Organize Schedules and Routines.” The following vignette
illustrates the use of a visual schedule.

Clarence was not interested in following the class schedule. He loves race cars, so the teacher put each activity during
the day on a visual of a race car. She made the schedule into a race track, with a starting line and finish line. He is
now following the schedule because he looks forward to putting up the next car on the track.

Social Cue Cards The main function of cue cards is to remind the child of what to do. Visual cue cards,
which can contain one or more pieces of information, replace verbal or other social prompts. They silently
refocus an individual’s attention, thus making cue cards less intrusive than other forms of prompts. Cue cards
are particularly useful for situations in which the child is disorganized and/or anxious. Examples of cue cards
include
• Card with a single message in pictograph or written form
• Dry-erase board
• Wristband worn by adult that contains key directions
• Lists of reminders
• Index card with social rules (e.g., share, take turns, wait)
The following vignette illustrates the use of social cue cards.

Bryan has an aide in his general education classroom who often prompts him using cue cards. For example, his aide
writes key words on a dry-erase board to visually cue Bryan during group discussions. When given these silent
reminders, Bryan’s attention increases in group activities. Another cue card used for Bryan is a STOP/GO sign on the
classroom door. Prior to using the cue card, Bryan often ran out of the classroom to see the fish tank in the library.
Bryan was taught when he can leave the classroom (i.e., when GO is displayed) and when he cannot (i.e., when the
sign reads STOP). In addition, STOP and GO signs are used throughout the classroom to clarify which activities are
available or unavailable for Bryan’s use.

Social Scripts The main function of social scripts is to present children with autism with a description of a
specific skill or situation (Fleury, 2013a; Wong et al., 2013). This description can serve as a model or clarify
choices in social situations. Social scripts can simplify open-ended social interactions by providing limited
options, such as two or more options of what to do in a social situation. Like schedules, social scripts can be
made with photos, pictures, pictographs, or written language. Unlike schedules, however, social scripts provide
more flexibility, and the information depicted on social scripts can be presented in a nonlinear sequence. Left-
to-right presentations, numerical lists, and outlines often prompt an individual to do activities in the order
presented. Social scripts can be presented in arbitrary ways. Examples include
• Circular board of different solitary or social play and leisure choices
• Play script, which might include a visual depiction of options within an open-ended activity that can be
presented as a series of individual cards held together by a key ring
• Checklist of activities that will occur in random order

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• Story about an upcoming event that includes “what to do” options
The following vignette illustrates the use of social scripts.

Using scripts helps Lance expand his repertoire of play and leisure skills for open-ended activities in the playdough and
dress-up areas. A series of cards that present different things to do were organized on a key chain. The playdough script,
for example, contains different cards that depict using a roller and cookie cutters as well as making playdough balls,
snakes, gingerbread men, and so forth. He reviews the choices, practices each play schema, and then has the social scripts
available at playtime. Lance’s peers use the scripts to cue him when he gets stuck.

Social Narratives The main function of social narratives is to clarify expectations for a particular social
situation and teach perspective taking and social cognition. Social stories can describe what occurs in a social
situation and why, point out the relevant features of a situation, list desired social behaviors, and describe the
reactions of others in the target situation (Collet-Klingenberg & Franzone, 2008; Wong, 2013b; Wong et al.,
2013). Sentences within the narrative are descriptive and directive and provide perspective (Gray, 2010). The
complexity of information within a social narrative must mirror the child’s language comprehension abilities.
In addition to teaching perspectives and coaching social skills, social narratives can be written to reduce fears.
For the child who does not read, social stories can be in audio or video format and/or include illustrations.
Examples of formats for stories include
• Written
• Fill-in-the-blank
• Checklist
• Comic strip
• Book
• Slides (e.g., PowerPoint)
• Video
• Audio
• Memo
• E-mail
The following vignette illustrates the use of social narratives.

For group activities, Tyler has learned to raise his hand but becomes upset when he does not get a turn. Agitation and
verbal outbursts are common. A short, simple story book about emotions was made for Tyler. It is previewed each day
and reviewed after each time he becomes upset. Tyler’s teacher verbally prompts him in group using the same words
from the story. Gradually, Tyler is using the words of the story to regulate himself when he is agitated. He has learned
to say, “Sometimes you get a turn; sometimes you don’t. I can stay calm.”

Video Modeling Video modeling can be used for acquisition of specific social skills (Buggey, Hoomes,
Sherberger, & Williams, 2011; Franzone & Collet-Klingenberg, 2008b; Plavnick, 2013; Wong et al., 2013).
Through video modeling, the child can learn to DO-WATCH-LISTEN-SAY. Videos can be developed to
highlight salient social cues and specific social and communicative behaviors. Some learners with autism may
prefer visually supported activities like videos because this type of instruction allows the person to view natural
social events in precisely the same way repeatedly. Unlike natural social interactions, which never occur the
same way twice, videos present identical reenactments over and over again. Videos are an easy way for the
child to preview and review social events, and this type of instruction can be used along with other visual
strategies. Because watching videos allows for the repeated review of unchanging social scenarios and
interactions, it might be that children who show interest in videos are seeking social predictability. Instruction
through video modeling may assist children with social understanding and communicative competence. Video
modeling has unlimited applications, but some examples include
• Teaching motor imitation (e.g., watch self or others doing actions and/or movement activities)
• Teaching solitary play and leisure (e.g., watch self or a peer engaged in a specific solitary play and leisure
sequence)
• Teaching social play and leisure (e.g., watch self or peers taking turns during a specific activity)

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• Teaching community expectations (e.g., watch self or a peer going to a community site such as the dentist)
• Teaching replacements to challenging behaviors (e.g., watch self or peer engaged in prosocial behavior)
• Teaching specific communication messages (e.g., watch self or others express a message in a variety of
contexts)
• Teaching discourse skills (e.g., watch self or peers engaged in simple conversations)
To develop a video for social skills or communication skills instruction, 1) identify the social setting, 2)
identify the target social behavior or communicative message, 3) make videos of individual, familiar adult(s) or
peer(s) engaged in the target behavior or using the communicative message, 4) make the social cues, target
social behavior, or communicative message the most salient aspects of the video, and 5) limit the amount of
verbal information on the video. The basic types of video modeling include
• Basic video modeling: video of another individual performing desired skill
• Video self-modeling: video of the student with autism learning desired skill or performing the skill
• Point of view modeling: video of learner’s point of view but does not show face of person performing the
skill
• Video prompting: video of behavior broken down into discrete steps that are recorded with a pause to stop
and provide prompt
There are some basic ideas to keep in mind when using video modeling for instruction, which include the
following:
• Show the video regularly (i.e., daily or more often if the child is interested).
• Preview the video just prior to the actual activity when appropriate.
• Pair the video model with a second visual cue (e.g., schedule, cue card, social script).
• Use the second visual cue as an instructional prompt in the natural social situation.
• Assess skill acquisition.
• Continue practicing the target social skill through the use of video and other visual cues as needed.
• Gradually fade the frequency of video preview until the skill is mastered.
The following vignettes illustrate the use of video modeling. In the first vignette, video modeling was a
helpful support for making trips to the dentist less challenging. In the second vignette, video modeling is used
to help teach communication skills.

Annie does not like to visit the dentist. She begins to scream as she nears the dental office building, and her reaction is
so extreme that two adults need to hold her for a routine exam. She does not want anyone to touch her teeth because she
associates dentists with toothaches. A video was made about a dentist visit for Annie. The video includes Annie’s sister
going to the dentist for a checkup. Annie’s favorite music accompanies the otherwise silent “movie.” The dentist slowly
checks the girl’s teeth and gums with instruments. She stays calm and receives Annie’s favorite treat after leaving the
dentist’s office. An activity schedule is paired with the video. Annie watches the video daily for two weeks. From then
on, she carries her activity schedule and video to the dentist’s office. Each visit has become easier for her.

Roger does not like it when his classmates borrow materials from his desk. He is extremely vigilant about protecting his
possessions, and this distracts him from his schoolwork. When a peer does ask to borrow something, Roger usually yells.
Efforts to cue him to communicate in an alternative way were not successful until his teacher tried video modeling. On
the video, his classmates act out multiple scenes of saying, “No, they are mine” when peers want to borrow materials.
The video consists of three friends and four different settings. Roger enjoyed watching the video at home and school and
used the message in the classroom perfectly within two days.

Sociobehavioral Displays The main function of sociobehavioral displays is to clarify rules and desirable
social behaviors. Teachers can provide a list of classroom rules that outlines social expectations to refer to
when communicating expectations. Putting rules in visual form ensures that adults will be clear and
consistent, and a display also can refocus the child’s attention and provide a concise and simple prompt when
the child exhibits undesirable behaviors. Displays can depict one or more rules, and they can be presented in
picture, pictographic, and/or written form. They can be used alone or in combination with other nonaversive
behavior management procedures. The following vignette illustrates the use of sociobehavioral displays.

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Ali’s peers are getting annoyed at the number of times she interrupts the teacher during lectures. One of the rules posted
on the sociobehavioral display at the front of the classroom is a QUIET visual. The teacher points at the visual to remind
Ali when she blurts out during the lecture.

Self-Regulation Visuals The main function of visual self-regulation interventions is to teach awareness
and self-control strategies. Several strategies fall under this category, such as visual imagery and visual self-
regulation supports. These types of interventions are grounded in cognitive behavior practices. Visual imagery
focuses on stressful events that are known to trigger challenging behaviors and supports the child in learning
alternative self-control strategies. Imagery procedures use repeated practice of desired social behaviors by
presenting the event in visual form. Visual imagery is used in practices such as mindfulness and meditation.
These practices focus on the mental state of being conscious or aware and calmly acknowledging, accepting,
and regulating feelings, thoughts, and sensations. Visual strategies that can be used to teach self-regulation
include quantifying emotions and feelings using a scale, thermometer, or zones. Some specific examples
include
• The Incredible 5-Point Scale (Dunn-Buron, 2012)
• Zones of Regulation (Kuyper, 2011)
• Emotional thermometer and rating scale (McAfee & Attwood, 2013)
• Visual imagery or picture rehearsal: A scene of a stressful situation is depicted as a sequence of pictures that
is paired with a simple verbal script (Baron, Groden, Groden, & Lipsitt, 2006). The scene concludes with
desired behaviors and positive outcomes. The scene and script are reviewed multiple times each day. Once
the child with autism demonstrates familiarity with the scene, the scene is rehearsed before, during, or
after the actual stressful situation. The goal is for the individual to demonstrate the desired behaviors in the
natural setting by using the visual and verbal images as cues.
The following vignette illustrates an example of visual self-regulation strategies.

Leslie has significant difficulties on the school bus. It was determined that the difficulties are triggered by the noise on
the bus. A pictorial scene of five photographs was developed that depicts the stressful event and what to do: 1) Leslie
gets on the bus, 2) Leslie sits on the bus, 3) peers talk and laugh loudly, 4) Leslie listens to music using headphones, and
5) Leslie gets off the bus and receives a hug from her mother. In situations in which others are loud, Leslie practices
putting on her headphones. The pictorial scene is reviewed during quiet times of the day. It also is practiced before and
after the bus ride. Gradually, Leslie’s challenging behaviors on the bus have been replaced by her self-control strategy of
listening to music.

Relaxation Cues The main function of a relaxation cue is to provide a visual cue that prompts the child
with autism to relax. Relaxation cues are an effective means to prompt an individual nonverbally when he or
she appears stressed. These cues also can be an effective way to nonverbally prompt the child to refrain from
restricted and repetitive behaviors. The cues can be objects, pictures, pictographs, or written language that
represents a relaxing location, object, activity, or procedure. A specific area of the classroom, a box of “fidgets,”
a display of activity choices, or a relaxation checklist are other examples of relaxation cues. The information
can also be presented in the form of a cue card or social script. Relaxation cues can visually cue the student
with autism to
• Go to a particular location to take a break
• Use a particular object to relax
• Select a particular activity to relax
• Use a particular sequence of relaxation procedures
The following vignette illustrates the use of relaxation cues to relieve anxiety and reduce restricted and
repetitive behavior at school and at home.

Alex often engages in noncommunicative delayed echolalia. He repeats scenes from a favorite movie. This behavior
seems to increase during stressful situations. Alex is now cued to relax in two ways. First, the rocking chairs in the book
area of his classroom and a similar chair in his bedroom are identified as places to relax. A rocking chair pictograph is
used to cue Alex to go to the area. Gradually, Alex has learned to hand the card to the adult to request a break. Second,
he has been taught a series of relaxation techniques that include deep breathing and counting. This relaxation
procedure is visually displayed on a portable card that can be used anywhere.

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 Social Decision-Making Strategies The main function of social decision-making strategies is to help
children with autism understand social situations. These tools can be used for interpretation or for instruction.
For example, they allow a child with autism to review a social situation in which a possible error was made and
choose an appropriate response to a social interaction, or they can be used in advance of a social situation to
prepare. Most of these visual strategies provide a step-by-step process by which children with autism learn to
analyze social situations and select how they will respond in a given situation. This is a helpful technique for
children who have difficulty generalizing skills across situations and environments. Some strategies that
provide visual social decision making include comic strip conversations (Gray, 1994), social autopsies (LaVoie,
2005), solving problems before they become problems (Garcia-Winner, 2015), and SOCCSS (Myles et al.,
2004). Social decision-making strategies can visually outline a social situation and help the learner understand
cause and effect and thus make an informed choice of how to respond.
SOCCSS is a strategy developed by Jan Roosa that uses six steps to dissect a social situation (Myles et al.,
2004). The learner with autism should be encouraged to complete these steps independently; however, it may
be necessary to assist. The six steps are as follows:
1. Situation: Identify who was involved, what happened, when it happened, where it happened, and why it
happened.
2. Options: Brainstorm more than one option that could be chosen as a response to social situations without
evaluating them.
3. Consequences: For each option, identify a consequence. “What do you think would happen if (name the
option)?”
4. Choices: Prioritize the options and consequences as those most appropriate or desirable by using a
numerical sequence or a yes/no response. Select the option that will be able to be accomplished and will
most likely obtain the desired consequences.
5. Strategies: Develop a plan to carry out the chosen option to use the next time the situation occurs. Fix or
remedy the present situation.
6. Simulation: Practice the chosen option. This can be accomplished in a variety of ways: 1) write down the
plan, 2) talk through the plan with another person, 3) visually imagine the plan, or 4) role-play the plan
and rehearse the steps in various situations.
The following vignette illustrates the use of a social decision-making strategy.

Abraham wanted to use the slide, and the peer in front of him was moving slowly. Abraham pushed the child down the
slide. When Abraham got to the end of the slide, the peer was still at the bottom and the two children collided, causing
tears and a visit to the nurse’s office. The teacher used a social decision-making strategy to review the situation with
Abraham so that he could see visually what other options he had available in that social situation. Abraham apologized
to his peer and has decided next time that he will say, “Can you please go?” He will also count to ten before he goes
down the slide after his peer.

When using any of the aforementioned visual supports during instruction and interaction, it is important
to make environmental and social information as clear as necessary. The child’s moment-to-moment ability or
inability to focus attention on relevant natural cues determines whether more salient environmental and social
cues need to be provided. It is essential to remember that learners with autism often have difficulty attending
to relevant cues, focus their attention on an irrelevant cue, and/or have difficulty attending to multiple cues
simultaneously.

COMMUNICATION SUPPORTS
Communication supports must be considered for the individual with autism who lacks motivation or a means
to communicate effectively. Table 7.8 describes types of AAC supports and for whom AAC should be
considered.

Table 7.8. Augmentative and alternative communication supports

If an individual… Then, consider augmentative and alternative communication support
Is nonspeaking Picture Exchange Communication System (PECS; Collet-Klingenberg, 2008; Frost & Bondy, 2002; Wong, 2013a)
Lacks verbal imitation skills Sign language
Depends on prompting to communicate Interactive communication boards
Has difficulty spontaneously initiating communication Communication cue cards
Has difficulty communicating in stressful situations Conversation books
Technology-based communication aids (voice output communication aids [VOCA], speech-generating devices [SGDs]) (Franzone & Collet-

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 Klingenberg, 2008a; Odom, 2013; Wong et al., 2015)

The different types of AAC supports for individuals with autism include both traditional forms of AAC
and innovative technologies to enhance functional communication. Communication is a broad field, so this
section is limited to a review of the most common AAC supports used in intervention for autism. These
include the following:
1. PECS (Bondy, 2012; Bondy & Frost, 2001)
2. Sign language
3. Interactive communication boards
4. Communication cue cards
5. Conversation books
6. Technology-based communication aids (e.g., VOCA, SGDs)

Picture Exchange Communication System

PECS, created by Frost and Bondy, is a system used to teach the process of communication and to facilitate
the emergence of speech in individuals with autism. There are six phases in PECS. In phase one, PECS helps
individuals develop spontaneous communication by teaching that communication is an exchange. The
individual is taught to make spontaneous initiations by delivering a pictorial message. To do this, the
individual hands a picture to a person in exchange for receiving a desired item or activity. The program begins
with highly motivating interests (e.g., toys, food, activities) to build requesting and then expands to labeling.
PECS is an EBP with reported outcomes that include the emergence of speech, use of picture symbols,
and use of a combination of speech and picture symbols to make requests and label items in individuals with
autism (Collet-Klingenberg, 2008; Wong et al., 2013). This method can be used to encourage spontaneous
initiations in verbal children and teach communication skills to individuals who rely on echolalia and lack
functional communication. PECS can be used to teach nonverbal ways to gain a listener’s attention prior to
conveying a message. In addition, PECS can be used to increase reciprocal eye gaze and communicative
gestures. The early phases of the PECS system can be used to expand additional communicative functions.
After the learner with autism has mastered the early phases, the PECS training includes procedures to
expand vocabulary and sentence structures to build requesting and labeling in multiple settings. As noted
previously, children should have a large repertoire of single words (i.e., symbols) to convey most
communicative functions (i.e., requests, negation, comments, feelings, prosocial communications) before
expanding sentence structure. PECS is beneficial in teaching verbal and nonverbal children to hand an adult a
symbol to request a break, indicate frustration, indicate fear (e.g., symbol for TOO LOUD), ask a question, and
say THANK YOU, among numerous other social functions (Quill, 1998). The basic steps for implementing the
PECS system include the following:
1. Teach the basic process of exchange. Do not use verbal prompts. Involve two adults, one who physically
assists (i.e., prompts) the child to send the message and one who receives (i.e., communication partner)
the message.
2. Systematically expand the distance that the child needs to travel to locate a person and convey a message.
3. Systematically expand the time that the child needs to persist in getting a person’s attention in order to
convey a message.
4. Systematically teach discrimination of two or more visual symbols to expand single-word functional
vocabulary.
The following vignette illustrates how PECS is used to support a nonverbal child’s communication skills
and reduce challenging behaviors.

Jessie demonstrates many challenging behaviors. He had limited success when intervention focused on his use of sign
language. His communication consisted of two signs: MORE and EAT. Because Jessie had excellent matching skills, the
PECS program was introduced to him. Within 3 months of using PECS, his vocabulary grew to include 50 words.
Jessie was able to convey eight communicative functions: requesting food, help, and favorite activities, as well as
indicating all done, no, yes, need a break, and feel mad. As Jessie’s communication increased, his challenging
behaviors decreased.

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Sign Language
The main function of sign language is to give individuals a system to communicate. American Sign Language
(ASL) is a complete language system with its own phonology, morphology, semantics, and syntax. Signed
Exact English is a system that matches the grammatical features of oral and written language. The problems
with motor planning and imitation in individuals with autism (Ming et al., 2007; Provost, Heimerl, & Lopez,
2007; Schurink, Hartman, Scherder, Houwen, & Visscher, 2011) can make it difficult to learn sign language.
Nevertheless, some studies have reported that people with autism acquired the sign language system they were
taught (Bartman & Freeman, 2003; Scattone & Billhofer, 2007).
When teaching sign language, practitioners can use total communication strategies, which is the combined
use of speech and sign. Total communication strategies model the same language structure in two modalities
for the child with autism. Nonverbal children using sign language should be exposed to total communication
across all settings. This requires a commitment from both home and the school community. Total
communication also can be an effective AAC support for some verbal children with autism. Signs serve as a
visual reference to highlight word meanings and enhance language comprehension. They also can improve
social attention and serve as a prompt in social contexts. Signed cues can expand expressive communication by
reminding the child of what to say. Given that the goal is spontaneous communication, however, it is
important to systematically fade both verbal and signed prompts. Some basic guidelines for implementing a
sign language system are as follows:
• Consider the complexity of sign position and movement when selecting early vocabulary. Signs that are
stationary (e.g., EAT, MORE) are easier than signs that move and/or require each hand to do a different
movement (e.g., JUMP, DONE).
• Exaggerate signs when using total communication by using slow movements and exaggerated positions
and by holding the position longer.
• Physically prompt the child to sign if he or she does not imitate motor movements. Use two adults to do
this, one who physically assists the child and one who receives the message. Systematically fade physical
assistance.
• Avoid using total communication prompts to elicit requests. This often leads to echolalic signing.
• Remember that the goal is spontaneous communication.
The following vignette demonstrates successful use of sign language to increase spontaneous
communication.

Tiffany has good social attention and motor imitation skills. Her family feels more comfortable using sign language
than other AAC systems. Through exposure to total communication at school and home, Tiffany’s communication has
grown from echolalic signing to signed phrases. Tiffany has successfully acquired an array of modified signs to
spontaneously convey numerous communicative functions.

Interactive Communication Boards

Interactive communication boards contain visual symbols—pictures, pictographs, or written words—
organized by topic. Communication boards can be created in different sizes and formats for different activities
and environments. They can be combined into a complete portable system or organized so that only one board
is used in one location. When selecting interactive communication boards as an AAC system, it is essential
that use of the communication system is modeled by adults and peers at all times. Sample interactive
communication boards include
• A series of single messages on a ring
• A wallet with multiple messages
• A single board with multiple messages or the alphabet
• A folder, book, or binder with multiple topic boards
Communication boards need to be portable, durable, and always available. Ambulatory children should
have boards that are easy to carry and readily available at all times. They can be attached to clothing, put in a
carrying case, placed in a pocket, or put in a book with a shoulder strap. If boards are too limited, children will
not be able to communicate their range of needs and ideas effectively. Selected symbols and communication
boards should be both compact and comprehensive.

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 The selection and organization of symbols should enhance motivating, functional communication. Boards
are generally created by topic (i.e., setting or activity). Vocabulary needs to be selected to allow for ease of
requesting and commenting in that particular context. This way, the child and others can use the board to
interact. A basic format is to organize the selected vocabulary from left to right so that the child and others
can generate a phrase or sentence in the person–verb-descriptive noun format. Pronouns and people are in the
left column, verbs in the second column, and so forth. Miscellaneous terms such as YES or NO and symbols
indicating phrases such as IT’S NOT ON MY BOARD are placed in the far right column. The number of words on
a board increases with time, but a basic format should be used from the onset.
Communication boards can be used with nonverbal children who understand how to gain a person’s
attention to convey a message and demonstrate an understanding of the symbol meaning, whether the
symbols are pictures, pictographs, alphabet, or written words. The use of interactive communication boards
can also be an effective AAC support for expanding the repertoire of some verbal children, because the visual
symbols can remind the child of what to say. Communication boards can be used with verbal children who are
inconsistent verbal imitators or are verbally prompt dependent and lack spontaneous communication.
Pictographic communication boards can expand the incidence of spontaneous communication, decrease
echolalia, and increase spontaneous commenting. Some basic guidelines for using a communication board are
as follows:
• Interact with the child by touching key words on the board while talking. Use a hand-over-hand point if
the child does not demonstrate shared attention to the board.
• Limit verbal prompting to elicit the child’s communication.
• Encourage the child to take your hand and point if there is poor shared attention.
• Acknowledge the child’s communicative attempts by imitating and expanding on his or her message. For
example, when a child points to the symbol for BUBBLES, the adult says (and points) “Bubbles, blow
bubbles,” emphasizing the BLOW symbol on the board.
• Remember that the goal is spontaneous communication.
The following vignette illustrates the use of a communication board and how use can broaden
communicative functions.

Vince is verbal, but his speech is predominantly noncommunicative. He is an inconsistent imitator. Through PECS,
Vince learned the purpose of communication. Once he was able to seek out a person to convey a verbal message, his
communication continued to be limited to simple requests. A series of topic communication boards were designed for
him. Through use of the interactive boards, Vince’s communication expanded to commenting and other social functions.
There was a dramatic increase in his level of spontaneous communication in contexts with access to communication
boards.

Communication Cue Cards

The main function of cue cards, an AAC support used primarily with verbal individuals, is to 1) remind the
individual what to say and 2) provide the individual with an alternative means of communication. Cue cards—
which contain one or more messages in picture, pictographic, or written form—replace verbal prompts and are
particularly useful for children who are prompt dependent.
Cue cards can be used to enhance specific communicative functions in children with autism, including
messages that the child needs to express across familiar and novel social contexts. Pictographic cards can be
used for teaching children with autism the functions of commenting on one’s action and asking who, what,
when, where, and why questions. Cue cards also can be helpful for stressful situations in which the child is
unable to verbalize and may need an AAC system to communicate his or her needs and feelings. Messages
such as “I don’t want it” to express refusal, “I need a break to relax” to interrupt work, and “I feel ______” to
express emotion can be communicated verbally and/or by pointing to a cue card. Cue cards also can be used to
increase conversational skills and peer interactions. The following vignette demonstrates how cue cards can be
used to support and increase peer interactions.

Cue cards are used to preview, review, and prompt conversational rules with Clark, who often interacts with his peers
in awkward ways. Three different-colored cards were made for Clark: one for conversation openers, one for
conversation fillers, and one for ending conversations. The card for openers includes a choice of “Hi,” “Hey,” or “What’s
up?” Cards regarding fillers remind Clark to answer questions or to say, “I don’t know” as well as to listen and to say,
“Wow,” “Really,” and “Yes” sometimes. To end, Clark’s card gives the choices “Bye,” “I have to go now,” and “See you

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later.” Clark practices using these phrases during conversations with adults. The conversation cue cards have helped
increase Clark’s peer interactions, especially in situations that are stressful for him.

Conversation Books
A conversation book contains pictorial, pictographic, or written summaries of conversation topics that can be
used to augment conversational abilities in individuals with autism. The conversation topics can be organized
in an actual (small) book. If there is not time to create a book, items can be placed in a wallet, box, or bag, or
they can be accessed through other portable means. The conversation book is used as a focus of conversation
with an adult or peer partner. Conversation books can be used by both verbal and nonverbal children.
To design and use a conversation book for a child with autism, first select age-appropriate topics of
conversation. Topics also need to be meaningful, so choose photographs, pictographs, and/or accompanying
written phrases of favorite people and things, as well as recent activities. Be sure to vary the content of the
conversation book, because experiences and interests change. Sample conversation books and topics that can
be used for most students with autism include the following:
• A series of photographs and/or pictographs that tell a story about a recent event or outing
• A series of photographs and/or pictographs that summarize the day’s school activities (e.g., to share with
family)
• A wallet with photographs of family and friends
• A wallet with photographs of the student engaging with favorite items
Conversation books organize the conversation by providing a concrete, visual means to share and maintain
topics. Encourage adults and peers to ask the child to share his or her conversation book to initiate an
interaction. The nonverbal child and his or her partner can look at the book and point at the photographs,
pictographs, and accompanying written phrases to maintain a conversational exchange. The books give a
verbal child with autism additional reminders of things to say. In addition to the previous examples of content,
conversation books can contain other reminders for children with more advanced social communication skills.
Examples include the following:
• A list of general conversation rules
• Suggested conversation openers, fillers, and endings
• Lists of situation-specific topics (e.g., what to say at the library)
• Lists of person-specific topics (e.g., what to say to the minister)
The following vignette illustrates how a nonverbal student with autism can share information using a
conversation book.

Alexa shares information about her school day with her parents through a conversation book. Alexa’s teacher made a
one-page form that contains photographs of her classmates and pictographs of school toys and activities. After each
activity is finished, Alexa and her teacher look at the form together. They circle the activity and draw a line from the
pictured activity to the classmate who participated with Alexa. Each activity is circled in a different color. Alexa takes
the form home and shares it with her parents. Using the photos, pictographs, and color cues, Alexa can “tell” her parents
what she did in school that day and who played with her in each activity.

Technology-Based Communication Aids

There are a wide variety of high-technology communication devices available that may be used for individuals
with autism. Examples include
• Speech-generating devices (SGDs)
• Voice output communication aids (VOCAs)
• Low- to high-tech AT devices
• Digital tablet applications and computer programs
The advantage of speech output devices is that they give nonverbal children a “voice.” The technology is
constantly changing and improving to create newer, faster, smaller, and lighter devices. Subsequently, devices
can become obsolete quickly. Because of the wide range of devices available and the diversity of children with
autism, it is essential to consult a person specializing in AT when evaluating technology options. Once the

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best technology options have been determined, a student’s educational team needs to develop a plan to select
vocabulary, size of symbols, layout, organization, and the best way to set up situations that encourage the child
to use the system for a variety of communicative functions. The process is ongoing and should be flexible as
the child changes and grows.
If the child with autism is ambulatory, the device should be small and lightweight. If a device is large in
size or heavy in weight, the technology will not be appropriate for use in the community; it may, however, be
useful in a classroom. Some devices are described in this section. Technology changes rapidly, so finding
information on the latest communication devices should always be the goal of the interventionist.
There are simple devices for children with autism who do not understand visual symbols, although one
must have an understanding of cause–effect to use these devices. The child learns to press a switch or button
to activate a prerecorded message. Consider having a peer of the same age and gender record the messages.
These devices include single-message dedicated SGDs that enable one message to be recorded (e.g.,
BIGmack by AbleNet) and even small audio-capturing devices. A single-message device helps the child gain
another person’s attention, such as a device that says, “Please come here.” A preprogrammed voice message
can also be used in a specific social setting, such as a device that says, “Happy birthday!”
A growing number of programmable devices and technology with speech output are available for
individuals who understand visual symbols, whether pictograph or printed words. Interactive communication
boards can be placed on a voice output system. The devices range from those that contain limited or short
messages (e.g., Cheap Talk by Enabling Devices) to fully featured computerized systems that contain an
unlimited number of messages and allow for keyboarding (e.g., DynaVox by Tobii Dynavox). There also are
many computer software programs and apps (e.g., text to talk) available for digital tablets or phones (e.g.,
iPads) that can be used to facilitate communicative interactions. When choosing a system, it is vital to take
into account the child’s abilities and interests. As with all other AAC systems, the child’s use of the device as a
means of functional communication is the primary consideration.
There are things to consider when a child with autism uses voice output systems. First, if the child engages
in challenging behaviors, consider the durability of the device. Many of the devices are not durable yet are
expensive. Second, if the child needs access to his or her communication system at all times, consider the
portability of the system, because some (e.g., computer based) are not portable. Third, if the child perseverates
and uses the device to hear a voice repeatedly without communicative intent, then it is important to model the
correct use of these devices and to assess the functionality of a device for the individual. The following
vignette illustrates the benefits and challenges of voice output systems.

Ian is a master on the computer. He is nonverbal but highly motivated to communicate. Because of his language and
communication abilities, Ian quickly outgrew a PECS and communication boards. Thus, a voice output system was
chosen as a means for Ian to converse with his family and peers. There are problems with a voice output device for Ian.
He prefers the voice to be loud, especially when he wants to emphasize his point.

Regardless of the form of AAC selected for the child or student with autism, it is the responsibility of
every person in that individual’s environment to model and support the use of the communication system. A
child learns about communication through exposure to other adults and peers using the system. It also is
important to clarify communication expectations in each social context. If the child is using more than one
system—both sign language and interactive communication boards, for example—then determine which
message (i.e., sign or picture) is to be used in which contexts and for what purpose. For example, a child may
more easily use an interactive board at meals and for tabletop activities and use signs in active play and leisure
contexts. However, the child needs only one symbolic means to convey a single message. For instance, if the
child with autism has a repertoire of signs and graphic symbols to communicate, he or she does not need to
both sign DRINK and also point to the graphic symbol of drink on the communication board. The expectation
to use multimodal communication systems for a singular message can place an unnecessary burden on the
communicator with autism and can be confusing.

BEHAVIORAL SUPPORTS
Organizational, social, and communication supports will vary within different environments as well as from
individual to individual. It is necessary to consider the specific characteristics of the child with autism when
selecting intervention practices and supports, recognizing that the child’s abilities will vary depending on the
social context. A key variable that must be considered when planning intervention and supports is the degree
to which the child’s challenging, restricted, and repetitive behaviors pose an obstacle to learning and what
supports need to be in place to ensure the child’s success.

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Challenging Behaviors
The challenging behaviors of some children with autism are complex and can create a great degree of
confusion for professionals and families. Challenging behaviors often reflect the level of the child’s social and
communication impairment as well as organizational challenges. Although some challenging behaviors occur
for other reasons (e.g., medical), the majority of behaviors reflect social or communication frustrations,
anxiety, intense preoccupations/interests, organization challenges, or discomfort in the physical environment.
Most challenging behaviors indicate that the child
• Does not understand what is expected
• Does not understand what to do
• Does not understand the social situation
• Does not know what to say
• Uses a skill but without understanding the meaning
• Finds the situation uncomfortable
• Feels anxious or overwhelmed
• Feels “driven to distraction”

It is not the intent of this book to address intervention for challenging behaviors directly; it is assumed
that most challenging behaviors are the child’s means of social communicative interaction or an attempt to
create order and comfort amid social chaos and disorganization. Given this assumption, all intervention
strategies that focus on the development of specific social and communication skills should produce positive
changes in other behaviors.
The acquisition of social and communication skills will replace many challenging behaviors, and
intervention that supports the development of skills will have a positive influence on the child’s self-control
and emotional well-being. However, restricted and repetitive behaviors, one of the hallmarks of autism, are
challenging behaviors of special consideration. Many professionals and families struggle to understand and
provide intervention for restricted and repetitive behaviors. A discussion of some strategies and methods to
address restricted and repetitive behavior follows.

Restricted and Repetitive Behaviors

Restricted and repetitive behaviors dominate the social and communication patterns of children with autism
more so than for typically developing children. Restricted and repetitive behaviors are observed in myriad
ways. This discussion is limited to restricted and repetitive social and communication behaviors during play
and leisure activities and repetitive verbalizations. (See previous chapters for an introduction to restricted and
repetitive behaviors.) Restricted and repetitive behaviors can be a manifestation of the child’s limited
understanding about what to do or say or may be part of a learned chain of events. States of excitement,
anxiety, boredom, and confusion can trigger these behavior patterns. In addition, the behaviors can occur as a
result of underlying medical conditions.
Intervention to decrease restricted and repetitive behaviors must take into account the function (i.e.,
reason) of the behavior, which varies from person to person. The intervention goals are to carefully monitor
the child’s behavior patterns and teach replacement social and communication skills where possible. Box 7.1
summarizes three main steps of intervention for restricted and repetitive behaviors, with important
considerations for each step. The three main steps for intervention are 1) assess the function of the behaviors,
2) plan intervention according to the assessed function, and 3) employ different strategies to engage the child
according to the assessed function.

Box 7.1. Intervention for restricted and repetitive behavior

1. Conduct assessments to determine the function of the restricted and repetitive behavior.
• Why is the behavior occurring (i.e., possible causes)?
• What happened before the behavior began (i.e., antecedents)?
• What other behaviors accompany the restricted and repetitive behaviors?
• What is the child’s emotional state while engaged in the behavior?
• What happens after the behavior occurs (i.e., consequences)?

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 2. Develop an intervention plan according to the function of the behavior.
• Shape the restricted and repetitive behavior into a replacement skill.
• Teach an alternative social or communication skill.
• Organize the physical environment to decrease confusion.
• Manipulate antecedents and modify the environment to increase the child’s comfort.
• Modify the style of interaction, such as gentle or nonverbal redirection.
• Reinforce the replacement skills.
• Provide medical support as needed.
3. Employ strategies to engage the child who has restricted and repetitive patterns of behavior.

After determining the function of the restricted and repetitive behavior, plan intervention to modify these
behaviors if they are obstacles to learning and social and communication development. Some of these
behaviors serve as an interactive communicative function, some are used to regulate one’s own actions, and
others are noninteractive emotional responses. Restricted and repetitive behaviors can be immediately
responded to and interrupted, redirected, shaped, replaced, or ignored, whereas antecedent-based
interventions and changes are made in the physical or social setting (Hume, 2013a; Neitzel, 2009a).
Organizational supports can be used to clarify expectations, decrease confusion, and lessen the intensity of
noninteractive restricted and repetitive behaviors. When addressing verbal restricted and repetitive behaviors,
it is important to respond to the inferred function of a verbal behavior, not the exact meaning of the verbal
message, as the child may or may not understand the meaning of the message. Focus on teaching the child
more effective ways to communicate in these contexts. The following vignettes illustrate restricted and
repetitive expressions stemming from a variety of functions, with suggestions for possible interventions.

Behaviors that produce excitement: Earl likes to spin things. Whenever he finds something round and shiny, he spins
it. While he is spinning an object, Earl ignores everyone around him and laughs loudly. If the behavior is pleasurable,
shape it into other appropriate play and leisure skills that provide similar sensory stimulation.

Behaviors that stem from discomfort: Michael twirls ribbons. His twirling behavior is more likely to occur when the
classroom is noisy. Although he often tries to perform this behavior in a hiding place, Michael looks at adults when he
twirls to convey to them his discomfort. If the behavior is an expression of discomfort or fear, redirect to an alternative
comfort object, modify the environment, and limit verbal interaction. If a behavior is an expression of anxiety, redirect
to a calm setting or activity and limit verbal interaction.

Behaviors resulting from confusion: Lena recites segments of books to herself. Her verbal behavior occurs whenever
there is an unexpected change during activities. She ignores others and reorganizes the items on her desk while reciting
lines from the book. If the behavior results from confusion, provide organizational supports to increase understanding
and limit verbal interaction.

Behaviors resulting from a lack of skills: Sally is motivated to interact with peers. However, she initiates interaction
by perseverating on the same question: “What color is your house?” Sally becomes agitated when her peers do not answer
and persists in asking the question louder and faster. She does not possess a large repertoire of verbal vocabulary. If the
behavior reflects limited skills, teach a variety of alternative skills.

Behaviors that are a learned pattern: Rose learns a play and leisure activity and then insists that the objects be used in
the exact same way each time. She is happy and interactive when she can anticipate the sequence of the activity and
engage in the same sequence of behaviors with others each time. If the behavior appears cyclic in nature, redirect to
another activity or a calm setting and monitor the patterns over time.

Behaviors that are a learned conversation: Louis enjoys maps and interacts with others by asking, “Where do you
live?” and then describing the roads in that town. Louis associates a particular person with a specific address and
becomes agitated if someone has moved. He insists that the conversation follow the same sequence of exchanges. If the
individual engages in verbal restricted and repetitive behaviors to interact with others, as in the case of Louis, respond
by acknowledging the person’s intent and prompt him or her to use an alternative message to achieve the same result. If
the verbal behaviors are noninteractive, use nonverbal redirection to another activity or calm setting that is more
organized and familiar.

Medical: No clear environmental antecedents have been identified for Henry’s habit of tapping his chest, which is cyclic
in nature. The behavior will occur for a few weeks every few months. His tapping is accompanied by a decreased

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ability to attend to familiar activities. Henry’s parents indicate that his sleep patterns, eating patterns, and level of
agitation change during these cycles as well. If a behavior is linked to possible medical needs, suggest that the family
seek advice from a physician and ensure that educational and medical services are integrated.

Intervention for Restricted and Repetitive Behaviors An intervention plan must be individualized and
driven by 1) assessment information, 2) medical information, and 3) an FBA (see Figure 7.1).

Figure 7.1. Restricted and repetitive behavior intervention plan sources.

The primary goal is to increase the child’s physical comfort and social understanding by teaching
replacement skills and providing supports, thereby decreasing the frequency and/or intensity of restricted and
repetitive behaviors. The intervention plan should incorporate a combination of strategies including the
following: 1) use medical support, 2) follow a PBS plan, 3) teach replacement skills, and 4) discover tools to
help the child relax and understand social expectations. Table 7.9 highlights key features that can be
incorporated in intervention plans addressing restricted and repetitive behaviors.

Table 7.9. Restricted and repetitive behavior: Key intervention features

Intervention features Description
1. Intervene early. Shape and replace behaviors before they become habitual and ritualistic.
2. Provide sensory supports. Provide age-appropriate replacement objects and activities.
3. Provide organizational supports. Provide concrete visual tools to clarify what to do, where to be, and for how long.
4. Teach replacement social skills. Target social skills based on assessment data.
5. Teach replacement communication skills. Target communication skills based on assessment data.
6. Teach replacement self-regulation skills. Target self-regulation skills based on assessment data. (e.g., teach relaxation routines).
7. Prepare for stressful situations. Use interventions (e.g., video modeling, social narratives, visual supports) to prepare for stressful or confusing situations.
8. Reinforce alternative behaviors. Use applied behavior analysis (ABA) procedures to change behavior patterns.
9. Limit access when feasible. Establish rules and boundaries to change behavior patterns.

Intervene Early Intervene early because it may be more difficult to change restricted and repetitive
behaviors the longer they continue. Consider that a restricted and repetitive behavior observed in a young
child may be inappropriate in an older individual, and it is more difficult to change when the behavior has
been engaged in for a long period of time. For example, the young boy who talks incessantly about Disney
princesses has peers who also enjoy Disney films at this age, but consider how this behavior will sound in a
teenager talking to his peers.
Provide Sensory Supports Provide comforting sensory objects and activities that are age appropriate. Select
sensory activities that are universally acceptable and realistic across a variety of social settings (e.g., home,
school, church, community). Examples include listening to music, watching a video on an electronic device,
carrying a textured object, or using a water bottle.
Provide Organizational Supports Increase the structure and predictability of social experiences through
the use of organizational supports. Use visual supports (e.g., photos, icons, simple written language, video
modeling) to clarify social expectations (e.g., DWLS). Artificially impose organization in open-ended
situations. For example, use a “first… then…” visual to stop a child from repeatedly asking, “What’s next?”
Teach Replacement Social and Communication Skills Teach alternative social and communication skills to
reduce or change restricted or repetitive patterns of behavior. A reduction of these behavior patterns that
function as an expression of social confusion can occur as the child acquires and generalizes skills (e.g., those
within the ASCS-2). For example, teach what you want the child to do or say in the situations in which he or
she is currently engaging in restricted and repetitive behaviors.
Teach Replacement Self-Regulation Skills Teach self-regulation and relaxation techniques for restricted
and repetitive behaviors that appear to function as an expression of anxiety. For example, have the child take

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three deep breaths rather than say “This is bad” repeatedly.
Prepare for Stressful Situations Use EBPs (e.g., visual supports, social narratives, video modeling) to
prepare the child for upcoming situations that trigger more intensive restricted and repetitive behavior.
Decrease confusion and anxiety that may, in turn, decrease behaviors that appear to function due to social
confusion. For example, provide a calendar at the beginning of the school year that notes the dates of planned
fire drills to decrease the student asking each day, “Is there a fire drill today?”
Reinforce Alternative Behaviors Systematically reinforce replacement behaviors. In addition to social and
communication replacement skills, it is sometimes helpful to identify alternative behavior that provides similar
sensory feedback. For example, a child who rocks his or her body is provided a rocking chair and reinforced
for its use, and a child who mouths inedible objects is reinforced for chewing gum.
Limit Access When Feasible Set limits around when, where, and how the child engages in the restricted
and repetitive behavior when there is a sensory or social function for the behavior. For example, a student who
wants to carry an unlimited supply of red objects is limited to “only three” and is reinforced for cooperating; a
child who wants to watch the same movie repeatedly is limited to 30 minutes and is reinforced for
cooperation; a child who enjoys twirling ribbons is allowed to engage in the behavior only at home; and a
child who asks the same question repeatedly is redirected after the second time and reinforced for cooperation.
Support Strategies for Restricted and Repetitive Behaviors Once the cause of an individual’s restricted and
repetitive behaviors is understood, additional steps can be taken to actively support and engage the person.
Most of the organizational, social, and communication supports that are discussed in this chapter will decrease
the frequency and intensity of restricted and repetitive behaviors. The following list provides some additional
guidelines and strategies for interacting with a child who is engaged in play and leisure or verbal restricted and
repetitive behaviors.
• Acknowledge the child’s intent, verbally or nonverbally.
• Use nonverbal redirection (i.e., silence is key).
• Simplify and slow down the pace of interaction.
• Present another highly motivating activity to interrupt, distract, or calm the child.
• Create a predictable, patterned response to draw the child’s attention away from his or her restricted or
repetitive behaviors and/or prepare the child for the interruption (e.g., silently count to five by holding up
one finger at a time, then redirect).
• Imitate the behaviors, create joint attention, then redirect or expand into more appropriate social or
communication interaction.
• Establish a turn-taking interaction involving the behaviors and then expand it into more appropriate social
or communicative interaction.
• For a play and leisure restricted or repetitive behavior, remove the object and indicate “First… then… (the
desired object)” using verbal, visual, and/or gestural prompts.
• If a verbal restricted or repetitive behavior is noninteractive, establish a rule for when and where the
behavior can occur (e.g., a visual cue that indicates the time and place for the child to talk about the topic).
• Establish logical rules for why the restricted or repetitive behavior must stop (e.g., if a child is
perseverating on turning the couch cushions around, show him the fabric tag and state the rule, “The
cushion tag goes in the back.”).
• Establish a precise rule for why a restricted or repetitive behavior must stop. For example, if child is
perseverating on a question, then establish the rule, “Ask one time.” This may not be effective when the
behavior is an expression of discomfort, confusion, or anxiety.
• Model and reinforce an alternative activity or communicative behavior. Focus on teaching replacement
skills.
• Be selective about responding to some restricted and repetitive behaviors and ignoring others.
The next two vignettes illustrate steps that use some of these intervention and engagement strategies for
restricted and repetitive behavior.

Jenny lines up books in a certain order and protests whenever someone touches them. To interrupt this pattern and to

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promote an expanded interaction with Jenny, her teacher uses counting to prepare Jenny for the interruption. The
teacher then takes one of the books. She immediately prompts Jenny to gesture It’s mine and rewards Jenny by handing
back the book. Intermittently, Jenny’s teacher takes a book, prompts the desired communication, and returns the book.
Jenny’s screaming has been replaced with her gesturing and saying, “It’s mine.” At this point, the solitary behavior has
been replaced with an interaction that can be further expanded through the use of joint activity routines.

Connor was lining up Lego blocks in a restricted and repetitive manner. His mother introduced a new activity
without removing the Legos. She sat next to Connor and began to play with a marble run. No directions were given to
Connor. His mother simply handed Connor a marble, which he put on the run before returning to his Legos.
Gradually, Connor and his mother took turns putting the marble down the run. His mother commented about the
game and slowly moved the activity away from the Lego blocks. A joint activity routine was created, and the Lego
restricted and repetitive behaviors terminated.

Remember that restricted and repetitive behaviors may reflect the child’s emotional state. Some of these
behaviors may be an emotional response to external events, whereas others may reflect internal states that are
independent of environmental factors. A growing body of medical research links ASD with anxiety disorders,
obsessive-compulsive disorders, movement disorders, and other neurological impairments (Russell et al., 2013;
South, Ozonoff, & McMahon, 2005; White, Oswald, Ollendick, & Scahill, 2009). Intervention to decrease
restricted and repetitive behavior must include careful monitoring of the effects of the intervention strategy.
Efforts to respond, interrupt, redirect, replace, or stop these behaviors can at times worsen the problem. The
following vignettes illustrate restricted and repetitive behaviors linked to an emotional state that required
careful consideration.

Oliver suddenly began a restricted and repetitive pattern of tapping objects three times before picking them up. When
Oliver was redirected, the behavior escalated into aggression. Careful assessment revealed that Oliver’s father started a
new job and was not home every night. Oliver was anxious about the change. When Oliver was given a visual
schedule and other visual cues to indicate when he would see his father, he gradually stopped the tapping behavior.

John frequently engages in excessive, noninteractive talk about Sesame Street. A program was designed to give John
different times during the day when he can talk about Sesame Street with an adult of his choice—as long as he refrains
from this talk at other times. John understands these expectations and tries hard to withhold his verbal restricted and
repetitive behaviors. His efforts to stop himself have resulted in crying and pushing his mouth closed, leading to self-
injurious behavior of his mouth. The program has been discontinued, and medical intervention was sought to resolve
the problem.

As John’s example indicates, intervention plans often require ongoing discussion with the child’s
physician. Intervention for restricted and repetitive behaviors must come from a point of view that recognizes
the complexity of ASD and shows respect for the child’s emotional, medical, and social–communication
needs.

SUMMARY
Providing supports to build skills in students with autism is a process that begins with identifying needed
organizational, social, communication, and behavioral supports to maximize learning. The combined use of
these types of supports enhances the environment and allows for the development of social understanding,
social skills, social interactions, and communication skills in children with autism. It is necessary to support
the development of multiple skills across multiple contexts in a flexible way to increase the quality of social
and communication skills in children with autism. The following chapter discusses how to use a variety of fun,
meaningful, and motivating activities as contexts for teaching and helping the child to generalize social and
communication skills.

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 CHAPTER 8

Activities to Promote Skill Development

LEARNING GOALS:
1. Learn how to develop and implement creative, motivating, and meaningful activities to meet an individual
learner’s goals and objectives.
• Understand how to provide systematic instruction embedded within the context of naturally occurring
activities and routines.
• Use strategies that facilitate reciprocal social interaction between the learner with autism and adults
and/or peer within activities.
• Use explicit cues, systematic prompts, scaffolding, and reinforcement strategies when instructing
learners during activities.
• Use strategies to facilitate spontaneity and generalization of skills.

T he success of intervention can, in part, be measured by the use of creative, motivating, and
meaningful activities. This chapter offers a variety of activity ideas to support social and
communication skills in children and youth with autism and provides activity sheets that correspond
to each of the Core, Social, and Communication Skills Checklists within the ASCS-2.
Approaches to teaching skills have long been split along developmental and behavioral lines. In theory,
these two historical approaches often are in discordance, but in practice, blending the two may elicit the better
result. Thus, the activities in this chapter are based on the more contemporary and naturalistic developmental
behavioral intervention approaches.
The recommended context for instruction is any natural setting that is motivating and meaningful.
Systematic instruction can be embedded within the context of naturally occurring activities and routines,
which increases the likelihood of meaningful interactions. It is generally understood that social–
communicative interaction occurs continuously and organizational, social, and communication skills are
required in most contexts. Thus, every moment is an opportunity to build competence.
The activity ideas provided in this chapter should be viewed as a starting point for designing social and
communication intervention across the child’s entire day. It is essential to individualize activity selection and
practice each skill across multiple activities and settings to ensure generalization.

ACTIVITY STRATEGIES
This chapter presents sample activities for building social and communication skills that involve the use of
behavioral instructional strategies in semistructured natural settings. In addition, suggestions for building
organizational skills through activities are also provided; building organizational skills involves the use of
support strategies in natural settings. The activity sheets give examples of modified interaction; behavioral
instruction; organizational, social, and communication support strategies; and steps to facilitate spontaneity
and generalization. These strategies and supports were discussed in detail in Chapters 6 and 7 and are
summarized below. The profile of the child with autism will ultimately determine which strategy is most
beneficial at any given point during an activity.

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Interaction Strategies
Consider the following strategies to facilitate reciprocal interaction:
• Frequently gain the child’s attention in order to initiate and maintain interaction.
• Systematically establish interaction routines during activities.
• Maintain close proximity to the child.
• Simplify language complexity.
• Use an exaggerated tone of voice to emphasize key words as appropriate.
• Give the child time to process and respond during activities.

Instructional Strategies
When instructing children with autism during activities, use the following behavioral strategies:
• Explicit cues: Clarify expectations with a visual, verbal, or gestural cue to signal an expected response.
• Systematic prompts: Provide additional physical, gestural, verbal, model, or visual signals to help support a
response, as needed.
• Planned scaffolding: Build on the child’s correct responses.
• Reinforcement: Provide natural social reinforcement.
Cues signal to the child with autism what is expected. Remember that clear, simple directions and
information assist the child to attend to the most relevant information.
When prompting a child during an activity, be sure to offer the maximal support needed to ensure success,
and aim to promote independence by using the least intrusive prompt possible. Also, be sure to develop a plan
to fade all prompts so that the child learns to respond independently.
When reinforcing the child for participating successfully in an activity, identify and use motivating objects,
events, and social activities. Because natural social reinforcement should ultimately motivate a child with
autism, pair tangible and social reinforcement from the outset with the goal of gradually fading tangible
reinforcers and emphasizing natural social reinforcers and rewards. Use and build on the child’s interests and
preferences, strategically embedding familiar interests within new social activities.

Support Strategies
To help compensate for the inherent complexity and unpredictability of social interaction, organizational,
social, and/or communication supports are usually necessary accommodations to include in activities (see
Table 8.1). If the child is not attending to the activity, the following sets of questions can help identify when
he or she may need additional compensatory supports:

Table 8.1. Compensatory supports to use during activities

Type of support Examples
Organizational supports Use a visual and/or auditory timer to indicate length of time.
Verbally count to 10 to indicate completion of activity.
Color code materials to designate what materials to share.
Designate spatial boundaries to clarify personal space.
Social supports Create social scripts for preview and review.
Write social narratives for preview and review.
Use video modeling for preview and review.
Communication supports Provide visual cues for expressive and receptive comprehension.
Provide augmentative and alternative communication systems.
Behavioral supports Teach relaxation and self-regulation procedures.
Reinforce alternative skills and behaviors.

• Is the activity organized?

• Are the expectations of the activity easy to understand?
• Is the environment distraction free?
• Is the activity motivating?
When the child with autism is difficult to engage, ask the following questions:
• Does the activity need to be previewed?
• Do the interaction patterns need to be modified?

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• Does the language match the individual’s level of comprehension?
• Does the child have a functional means to communicate in the activity?

Strategies to Facilitate Spontaneity

Spontaneity is not necessarily a teachable skill. Spontaneity depends on whether an individual recognizes and
uses environmental and situational cues that prompt what to do or say within the context of the activity.
Strategies to foster spontaneity include the following:
• Make environmental cues more salient. Provide visual cues to “remind” the child of what to do or say.
• Use prompts paired with pausing to signal a response, and then gradually fade the prompts to facilitate
spontaneity.
• Identify when the child is most likely to spontaneously demonstrate a specific skill (e.g., what activity, with
whom, and when) and practice that social interaction across many adults, peers, and settings (e.g., home,
school, community).

Strategies to Facilitate Generalization

Most of the activity sheets in this chapter describe dyad (i.e., adult and child with autism) activities and small-
group activities with a peer or peers. The following are some techniques that help facilitate skill generalization
to peers:
• Provide training to peers so that they understand the characteristics of autism.
• Teach peers how to interpret behaviors and respond to the initiatives of the learner with autism.
• Coach the peers through interactions.
• Model strategies that are successful between adults and the learner with autism.
• Shadow the learner from behind, nonverbally moving him or her through the activity and supporting all
communicative interactions toward a peer.

USING THE SAMPLE ACTIVITY SHEETS

The interactive activities in this chapter are suggestions to encourage skill mastery and are not intended to be
practiced in isolation. The child or young person with autism, not the arbitrary boundaries of a specific
activity, should shape the interaction. Respect the individual’s preferences, motivation, and interest when
planning which activities, strategies, and supports to adopt.
The activity sheets offer creative ideas, suggestions, and strategies for engaging children with autism in
activities to enhance their development of social and communication skills. Depending on the goals and
objectives being targeted for instruction, some sheets contain specific activity ideas in which to embed and
practice skills, whereas other sheets contain more general strategies and compensatory supports that help
promote optimal engagement and participation in activities and daily routines. These activity sheets all have
similar formats. There is one activity sheet for each domain in the Core, Social, and Communication Skills
Checklists included in the ASCS-2. The general domain (e.g., joint attention, motor imitation) is listed at the
top of the sheet, followed by two sets of suggested activities and/or strategies and supports. The first set of
activities is geared toward adult-led one to one interactions, and the second set of activities is for peer and
small-group interactions. Remember that most skills are typically mastered during adult-initiated interactions
prior to occurring in a peer or group setting.
The sample activities and suggestions can serve as a springboard to develop other ideas for intervention.
The activity sheets are meant to generate ideas for encouraging practice of the target skill. Most activities
focus on creating fun and motivating exchanges between a child with autism and a partner. The activities
emphasize the need to use the child’s interests, which should become a necessary and reinforcing component
of the interaction. When referring to the activity sheets and the interactive techniques, think about how
activities initially facilitated by adults can be generalized to peers. Each Activity Sheet concludes with
suggestions for expanding the skill to new contexts to promote generalization.

Core Skills Activities and Supports

The core skills activity sheets offer ideas to build skills in the areas of: 1) nonverbal social interaction, 2)
imitation, 3) organization, and 4) self-regulation. The sample activities outlined on the nonverbal interaction

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and imitation sheets are based on a comprehensive spectrum of behavioral and developmental strategies. The
organization and self-regulation activity sheets are formatted a bit differently in that they outline a series of
suggested strategies and compensatory supports that can be used to help engage the student with autism in
activities. The strategies should help the child with autism understand where he or she is supposed to be, what
the activity is and what his or her choices are, how long the activity will be, when he or she will be done, what
he or she is expected to do or say, whose items are whose, and how to stay calm and focused.

Social Skills Activities

The social skills activity sheets describe activities for the three general aspects of social development: 1) play
and leisure skills, 2) group skills, and 3) social perspective-taking skills. There is a set of activity sheets that
corresponds to each of these areas within the Social Skills Checklist of the ASCS-2. The activity sheets for
play and leisure list suggested activities and strategies for building play and leisure skills in the domains of
solitary and social play. Group skills include three domains: 1) attends, 2) takes turns, and 3) follows direction.
The two domains in the area of social perspective-taking skills are 1) emotional understanding and 2)
friendships.
The design of intervention for social skills activities is built on the basic DWLS framework. It is assumed
that the child first learns what to do, then whom to watch, then how to interact with others. For example,
solitary play and leisure begins with simple actions with one object in closed-ended activities and develops into
multiple actions within open-ended activities. In social play and leisure, the child first learns to observe others
by sharing space, then to take turns, and later to cooperate with others. In group activities, the child first
learns to attend to one person, then to watch others in the group, and finally to interact in structured and
unstructured situations.

Communication Skills Activities

The communication activity sheets focus on intervention to enhance three general areas: 1) basic
communication skills, 2) socioemotional skills, and 3) basic conversational skills. This set of activity sheets
corresponds to each subsection within the Communication Skills Checklist of the ASCS-2. When using the
activity sheets, think about messages that the child may use to demonstrate the target skill using both gestural
and verbal means. The following are examples of sample means for communicative messages:
• Nonverbal: Physical proximity, looking at person, moving person’s hand/face, reaching, pulling person’s
hand, giving objects, moving objects toward or away, contact or distal pointing, shaking/nodding head,
open palm request, waving, shrugging, touching self, and acting out action.
• Verbal: Speech, signs, photographs, pictographs, an SGD, a voice output system, or written language to say
or convey messages. Begin with single words and then progress to multiword messages.
The importance of increasing the child’s repertoire of basic communicative functions, socioemotional
skills, and basic conversational skills cannot be stressed enough. It is preferable that the individual is able to
communicate multiple functions rather than be able to speak in expanded sentence structures that serve only
one function or represent only one conversational exchange. In other words, the child who speaks in single
words and is able to initiate requests, make comments, and express feelings as well as respond to others is a
more successful communicator than a child who speaks in full sentences and communicates only one function.

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CORE SKILLS ACTIVITY SHEETS
1. Nonverbal Social Interaction Skills: Joint Attention
2. Nonverbal Social Interaction Skills: Nonverbal Gestures
3. Imitation Skills: Social Awareness
4. Imitation Skills: Motor Imitation
5. Imitation Skills: Verbal Imitation
6. Organization Skills: Organizes Materials
7. Organization Skills: Organizes Choices
8. Organization Skills: Organizes Time
9. Self-Regulation Skills: Transitions
10. Self-Regulation Skills: Emotional Regulation

SOCIAL SKILLS ACTIVITY SHEETS

1. Play and Leisure Skills: Solitary Play and Leisure
2. Play and Leisure Skills: Social Play and Leisure—Structured
3. Play and Leisure Skills: Social Play and Leisure—Unstructured
4. Group Skills: Attends in Group
5. Group Skills: Takes Turns in Group
6. Group Skills: Follows Group Directions
7. Social Perspective-Taking Skills: Emotional Understanding
8. Social Perspective-Taking Skills: Friendships

COMMUNICATION SKILLS ACTIVITY SHEETS

1. Basic Communication Skills: Makes Requests
2. Basic Communication Skills: Basic Responses
3. Basic Communication Skills: Answers Questions
4. Basic Communication Skills: Comments
5. Basic Communication Skills: Asks Questions
6. Socioemotional Skills: Expresses Basic Feelings
7. Socioemotional Skills: Expresses Complex Feelings
8. Socioemotional Skills: Prosocial Statements
9. Basic Conversational Skills: Verbal Reciprocity
10. Basic Conversational Skills: Verbal Topics
11. Basic Conversational Skills: Nonverbal Conversation

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 CHAPTER 8
CORE SKILLS ACTIVITY SHEETS

1. Nonverbal Social Interaction Skills: Joint Attention

GOAL: INCREASE JOINT ATTENTION
SAMPLE OBJECTIVE: During a familiar activity, learner will spontaneously alternate eye gaze between partner and object and
back to partner for 1 or more minutes in 80% of observations.

SAMPLE ACTIVITY: One-to-one with adult

Contexts: Motivating and familiar play and leisure activities
Materials: Preferred objects (e.g., train, train tracks, train conductor puppet)
Procedures:
1. Position yourself at learner’s eye level.
2. Call learner’s name to get him or her to look at you.
3. During a natural pause in familiar activity, pick up motivating item (e.g., train) with which learner is engaged.
4. Place item in front of learner’s face, and then lead it to your face.
5. Wait for learner to visually track the object and transfer his or her eye gaze and look at you.
6. Reinforce learner’s behavior by handing him or her the item when he or she looks at you.
7. To continue the interaction, make a reinforcing sound (e.g., “choo choo,” finger snap, clap, whistle). Catch learner’s eye gaze when he
or she turns toward noise.
8. To expand the interaction, place your finger in front of learner’s face and then point to an object of interest (e.g., train conductor
puppet).
• Use an animated verbal direction (e.g., “Look!”).
• Prompt learner to orient to object and then label object (e.g., say, “That is a train conductor”).
• Reinforce learner after he or she looks at object and then back at you by giving learner the desirable item.

SAMPLE ACTIVITY: Small group with one or more peers

Contexts: Structured play and leisure games
Materials: Preferred objects to hide and give as prizes (e.g., candy, baseball cards)
Procedures:
1. Tell learner and peer(s) you are going to play an I Spy game. Show learner and peer(s) motivating objects that are prizes to win during
the game.
2. Explain they will have to follow your eyes to find the prize. Point at your eyes as you say this.
3. Have them cover their eyes or turn away.
4. Hide the motivating object.
5. Have them open their eyes.
6. In an exaggerated manner, look with your eyes where the object is hidden while saying, “I spy with my eyes a prize.”
7. Encourage them to follow your eye gaze to where the object is hidden.
8. Require them to make eye contact with you to provide a guess as to where the object is hidden.
9. Praise those who follow your eye gaze and guess the location of the object correctly.
10. Give the object to one person who describes or points to the spot where the object is hidden.
11. Have winner show the object to each peer while making eye contact with him or her.
12. Alternate turns to hide and find prizes so that everyone wins multiple times.

WAYS TO GENERALIZE SKILLS

• Look at shared objects and make eye contact with peers during Show-and-Tell.
• Look at snack and make eye contact with teacher to receive food during snack time.
• Say name to get partner’s attention and make eye contact before tossing or kicking a ball back and forth during a reciprocal turn-taking
activity.
• Make eye contact with peer after completing a video game level.
• Hand item to cashier and make eye contact while paying for a purchase at the store.

2. Nonverbal Social Interaction Skills: Nonverbal Gestures

GOAL: INCREASE NONVERBAL GESTURES
SAMPLE OBJECTIVE: During a structured interaction, learner will spontaneously use two conventional gestures (e.g., point to
request, greet, wave goodbye, shake head no) in three of four observed opportunities.

SAMPLE ACTIVITIES: One-to-one with adult

Contexts: Motivating play and leisure activities
Materials: Preferred and nonpreferred objects
Procedures:
Activity Idea 1: Start activity by waving hello to learner. Encourage learner to wave hello back to you. Give learner a choice of two objects,
one highly motivating (e.g., Lego) and one not as desirable (e.g., block). Have learner point to which one he or she wants. If learner
points at the nonpreferred item, give it to him or her. If learner selects the preferred item, engage in a motivating activity with the object.
For example, hand learner each Lego as he or she works on building a tower.
Activity Idea 2: While completing a Lego activity (or other motivating activity depending on learner’s interests and preferences), stop the
activity at various points and wait for learner to look at you, and then hold up two different colors of Legos. Have learner point at one of
the Legos to receive it.

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 Activity Idea 3: Encourage learner to point by pretending to lose the motivating object.
1. Put motivating object in a location, such as on your head.
2. Exaggerate, and in an animated tone, ask learner, “Where’s the Lego?”
3. Have learner point at object, and give it to him or her when he or she points at it.
4. To provide another way to make a choice, have learner point at a visual board with No, Yes, or I don’t know listed as choices.
5. To expand the activity, ask learner a simple question. Prompt learner to shake his or her head back and forth to indicate no, nod head
up and down to indicate yes, or shrug to indicate that he or she doesn’t know the answer. Teach gestures to go with each choice.
6. End the activity by waving goodbye to learner.
7. Encourage learner to wave goodbye to you.

SAMPLE ACTIVITY: Small group with one or more peers

Contexts: Snack time activities
Materials: Preferred food items
Procedures:
1. Sing a modified version of “If You’re Happy and You Know It” called “If you like it and you want it, point at it.”
2. Give a choice of two snack items, one highly preferred (e.g., goldfish-shaped cracker) and one not as desirable (e.g., raisin).
3. Model singing the song and pointing to a desired snack item.
4. Sing the song and have peer model point to which one he or she wants.
5. Prompt learner to imitate action as needed.
6. Give learner the food item when he or she points to it.
7. Repeat singing and pointing activity every time anyone wants more of a snack item.

WAYS TO GENERALIZE SKILLS

• Have learner point to request paint during art activity. Set up art materials for learner and peer. Model pointing to different sections of the
paper. Request learner to paint in those spots. Then, switch and have learner direct peer to paint by pointing. Keep interaction fast paced and
somewhat silly, using exaggerated intonation and the simple verbal direction “Here!” while pointing. Alter vocal pitch to keep learner
engaged.
• Teach learner to point to request an out-of-reach item by structuring a scenario within a natural setting. For example, blow bubbles and then
place bubble container on a high shelf that is in sight but out of reach. Learner will need to request help to get the bubbles by pointing to the
object.

3. Imitation Skills: Social Awareness

GOAL: INCREASE SOCIAL AWARENESS
SAMPLE OBJECTIVE: During a familiar and motivating activity, learner will remain in proximity and watch others for a
minimum of 5 minutes in 80% of observations.

SAMPLE ACTIVITY: One-to-one with adult

Contexts: Motivating play and leisure activities
Materials: Preferred objects (e.g., farm animals, barn, train, tracks), visual timer, and divider
Procedures:
1. Set up environment to keep learner in proximity and watching. For example, use dividers to remove distractions and indicate area in
which the activity is taking place. If learner has difficulty sitting on the floor, allow him or her to sit on a chair in close proximity.
2. Set up familiar motivating activities based on learner’s interests. For example, if learner likes animals, then focus activity on an animal
theme.
3. Set timer to show learner expected time he or she must remain in location.
4. Follow learner’s lead playing with animals and barn until shared attention established.
5. Use exaggerated or animated tone of voice to make sounds for the farm animals (e.g., mooo) to help maintain learner’s attention during
activity.
6. Build on learner’s actions and use familiar cues to prompt him or her to imitate novel actions relevant to the context. For example, if
learner has mastered putting cows in the barn, expand and have him or her milk the cows. For learner who likes trains, set up two boxes
of materials so that both you and learner can build your own track and play parallel to each other. Begin singing a song about trains to
prompt learner to imitate putting the track together.
7. To maintain learner’s attention during activity, use an exaggerated or animated tone of voice or make interesting movements.
8. To sustain imitation and interaction, scaffold play. If learner has mastered pushing trains around the track, expand and have him or her
imitate stopping the train at a station. Model your train stopping to pick up passengers first. Prompt individual to imitate the action
before returning to the familiar activity. Alternate imitating learner’s train play with your own.

SAMPLE ACTIVITY: Small group with one or more peers

Contexts: Structured play and leisure games
Materials: Preferred objects and carpet square
Procedures:
1. Place carpet square on the floor so that learner knows where he or she is supposed to be and to help learner remain in proximity to
peer(s).
2. Play a game, Copy the Action, where one imitates peer and then adds something to the sequence.
3. Have learner watch peer model the first action.
4. Have learner imitate peer’s action.
5. Add a second action.
6. Add a third action to the initial and second actions.
7. Continue the activity until someone is unable to imitate all of the actions in order.

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WAYS TO GENERALIZE SKILLS
• Have learner add in novel words (e.g., weather variations) during consistent daily routines in which the group identifies weather.
• Have learner remain seated with a group and fill in a repeated phrase from a familiar book read by the librarian at the library.
• Have learner remain in proximity to others and watch a band concert in the community, imitating clapping at end of songs.

4. Imitation Skills: Motor Imitation

GOAL: INCREASE MOTOR IMITATION
SAMPLE OBJECTIVE: After an action has been modeled, learner will imitate a single action in three of four opportunities.

SAMPLE ACTIVITY: One-to-one with adult

Contexts: Meal and classroom activities
Materials: Cafeteria meal tray and visual supports
Procedures:
1. Embed imitation sequences within the context of natural, familiar, and routine activities.
2. Conduct a task analysis to identify a routine step by step.
3. Teach routines one action at a time. For example, teach learner to imitate you picking up the lunch tray.
4. When teaching action sequences, clear the area and set out only the materials relevant to the targeted activity.
5. Once the action sequence is mastered, set up the area for learner and leave him or her to perform independently. Allow the materials to
act as the prompt for completing the routine.
6. Teach ways for learner to get help when it is needed through actions that involve motor movements, such as raising a hand in an
academic setting. Model hand raising at appropriate times and have learner imitate this action to gain help.

SAMPLE ACTIVITIES: Small group with one or more peers

Contexts: Motivating play and leisure activities—Story or music
Materials: Preferred objects (e.g., books, props)
Procedures:
Activity Idea 1: Engage the group in familiar books or songs. Isolate a single action from a story or song, then give each person in the group
the action to perform. Have the group imitate the action at the appropriate point in the story or song.
Activity Idea 2: Sing “If You’re Happy and You Know It” or play a game such as Simon Says in which actions are imitated.
Activity Idea 3: Play a pretend game and provide multiple pictures of animals or occupations from a book or flash cards. Have group
members imitate one body action for each animal or occupation. Model a second action once learner has repeatedly executed a mastered
single play action. The new action should logically follow the first action in sequence. For example, have a peer model pretend to be a
parent. First rock the baby doll and then put the doll to bed. Have learner imitate.
Activity Idea 4: Make a fun game and prompt the group to follow a two-step sequence, attaching simple verbal directions to cue the target
actions (e.g., “Jump up, jump down”; “Put in, take out”). Use an exaggerated or animated sing-song manner during modeling.

WAYS TO GENERALIZE SKILLS

• Have learner imitate actions after watching a video modeling sequence in a community setting.
• Have learner imitate simple steps from a visual cookbook during cooking activities.
• Have learner imitate actions from a storybook during reading theater activity.
• Have learner imitate physical movements while moving through an obstacle course.
• Have learner imitate a familiar motion in classroom. For example, teacher signals silence by raising two fingers. Students stop talking and
imitate teacher, raising two fingers silently.

5. Imitation Skills: Verbal Imitation

GOAL: INCREASE VERBAL IMITATION
SAMPLE OBJECTIVE: After a verbal model, learner will imitate vocalizations/sound effects and/or one or more spoken words
during three of four opportunities.

SAMPLE ACTIVITIES: One-to-one with adult

Contexts: Structured and motivating communication activities
Materials: Preferred objects
Procedures:
Activity Idea 1: Get learner’s attention and imitate “ooo” if he vocalizes “ooo.” Add another sound such as “eee” once turn taking is
established. Prompt learner to imitate “ooo eee.”
Activity Idea 2: Show a desired item and label item during a familiar activity. Couple your labeling with a sign or pictographic representation
that says, Say ________, with a picture of the expected response. Prompt learner to verbally imitate the label using the visual as a cue.
First, fade the Say pictograph and then the picture. Provide reinforcement by giving learner time with desired item when he or she
verbally imitates the label.
Activity Idea 3: Have learner build a block tower if he or she loves blocks. Add a simple sound effect to the action (e.g., “crash”) when learner
knocks the tower down. Model other words needed for the activity. Prompt learner to imitate the words.
Activity Idea 4: Engage in reinforcing motor play in which the imitated word elicits an immediate, reinforcing action. For example, say “up”
and then lift learner up when he or she imitates you.
Activity Idea 5: Label actions using simple verb phrases while learner is reading a book or watching a video. Imitate action with learner using
the same language. Have learner imitate the words.
Activity Idea 6: Imitate action words such as “swing” or a comparable phrase on the playground. Push learner on the swing when he or she

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 imitates the phrase or an approximation of it.

SAMPLE ACTIVITIES: Small group with one or more peers

Contexts: Motivating and meaningful communication activities
Materials: Preferred objects (e.g., bubbles), treasure chest, or grab bag
Procedures:
Activity Idea 1: Have group blow bubbles. Say “pop” as you pop the bubbles. Have group imitate the sound while popping bubbles.
Activity Idea 2: Read favorite books or sing simple songs with repeated sound effects to imitate, such as “Old MacDonald Had a Farm.”
Activity Idea 3: Set up a treasure chest or grab bag filled with familiar and novel items that have associated actions. Go around and have each
individual pick an item (e.g., ball). Tell the group “It’s a ball.” Model the action associated with the object (e.g., bounce the ball). Have
entire group name the object and imitate the action.
Activity Idea 4: Play a familiar game such as Duck, Duck, Goose with a group of peers. Provide a new prompt for each time around the
circle. Prompt learner to play the game and imitate new words when it is his or her turn. For example, “duck, duck, grey duck” or “peanut
butter, peanut butter, jelly.”

WAYS TO GENERALIZE SKILLS

• Find natural situations and have learner imitate a word learned in a familiar context in a novel setting.
• Use favorite songs that allow for imitation at intermittent parts and have learner fill in the blank, such as “Happy birthday to ________.” Have
learner imitate the word you.

6. Organization Skills: Organizes Materials

GOAL: INCREASE ORGANIZATION OF MATERIALS
SAMPLE OBJECTIVE: Provided with visual supports, learner will organize own materials during three of four observations.

ACTIVITY SUPPORTS AND STRATEGIES: One-to-one with adult

Contexts: Routine activities in which frequent prompts are required to organize materials
Materials: Organizational tools (e.g., bins, folders) and visual supports (e.g., labels, photos, checklists)
Procedures:
• Define spatial boundaries in classroom by 1) reducing clutter; 2) establishing predictable locations for items (e.g., label designated bins,
folders, lockers, drawers); 3) separating large spaces into smaller, defined areas, and 4) taking out a single item or piece of technology or
completing one activity at a time.
• Teach learner to store personal belongings and supplies in designated locations and storage items that include learner’s photo and/or name.
• Have learner look at a checklist before activities that includes pictures of the items he or she will need for next task (e.g., paper to write on,
pen to write with).
• Have learner locate all required materials.
• Teach learner how to keep materials in order. For example, use a visual within the desk that shows where everything should be (e.g.,
photograph).
• Make learner responsible for acquiring and keeping track of own belongings (e.g., coat comes in with learner from recess).
• Have learner clean up and place all materials back in correct location (e.g., labeled shelf) at the end of an activity.

ACTIVITY SUPPORTS AND STRATEGIES: Group with one or more peers

Contexts: Routine activities in which frequent prompts are required to organize materials
Materials: Organizational tools, visual supports (e.g., masking tape, stop signs), and carpet square
Procedures:
• Segregate floor space by assigning each individual a carpet square that designates where to sit on the floor.
• Play a modified game of musical chairs. When the music stops, whichever chair learners are facing becomes their designated seat for group
time.
• Label shelves, bins, boxes, and drawers used by everyone in the group with representational labels (e.g., pictures, written labels) to identify
the items contained in those spaces.
• Section off areas by marking boundaries on the floor with colored masking tape.
• Color-code objects that belong in a respective area. Mark bins, folders, shelves, closets, or drawers with colors that correspond to the color-
coded items and designate where they should be placed.
• Cover items not in use or use stop signs to represent items that are not a choice.

WAYS TO GENERALIZE SKILLS

• Have learner use an individualized place mat (e.g., specific color, written name or photograph on it) with an outline of a place setting during
meals to keep track of placement of food and items.
• Have learner complete assigned to-do task during a group activity in the community. For example, one person gets books, one person gets
paper, and one person gets pencils.
• Have learner locate and select a game before playing a turn-taking game with peer. Have learner keep all game materials on the table. At the
end of game, have learner put game away in the correct box and on the correct shelf.

7. Organization Skills: Organizes Choices

GOAL: INCREASE ORGANIZATION OF CHOICES
SAMPLE OBJECTIVE: At the beginning of a familiar routine when provided with two choices, learner will make a preference
choice in 80% of opportunities.

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 ACTIVITY SUPPORTS AND STRATEGIES: One-to-one with adult
Contexts: Motivating and meaningful activities that require choice making
Materials: Two objects (i.e., one preferred and one nonpreferred) and visual supports (e.g., photo, pictographic, written)
Procedures:
• Present learner with one preferred and one nonpreferred object. Clearly establish choices by not adding to choices once they have been
presented. For example, line up choices on a shelf. Cover the rest of the shelving with a sheet to block other items from view or place stop
signs or an X on items that are not a choice.
• To provide another way to make a choice, use choice boards or pictographic or photographic representations of the choice items labeled
with the written word. Visually present choices in a linear or circular pattern. Place choice boards on doors or in drawers, cabinets, or
containers, or embed them within technology.
• Ask whether learner wants object 1 or object 2.
• Prompt learner to make a choice and point to or touch the object he or she desires as needed.
• To continue choice-making activity, have learner choose the activity he or she desires when using a token economy or other reinforcement
system.
• To expand choice making, present learner with a choice of two activities that must be completed. Have learner prioritize and choose the
order in which he or she will complete the activities.
• Use a first…then… chart paired with a verbal “First…then…” so learner can see and hear the choices that are available.

ACTIVITY SUPPORTS AND STRATEGIES: Small group with one or more peers
Contexts: Motivating and meaningful activities that require choice making
Materials: Motivating and preferred objects, visual supports, turn-taking game, photographs, and game cards
Procedures:
• Create a board with photographs of all peers in the group. Have learner choose peer partner from the photographic choices prior to
transition or any activity conducive to partnering. Move the peer’s photograph to the taken or not a choice section of the board once learner
has chosen a partner.
• Present learner with two choices of games before a turn-taking game with peer.
• Play a game called “Would You Rather?” Show learner and peers pictures on cards and ask would you rather questions (e.g., “In summer,
would you rather wear a sweater or a t-shirt?”).

WAYS TO GENERALIZE SKILLS

• Hand each member in a group a key with his or her name and photograph on it. Direct individuals to make a choice with the key. For
instance, the group members choose a free-time activity or area by placing a key on a hook in the area to indicate their choice. Another option
is to have keys represent available areas/activities and have individuals choose from a field of keys on a choice board. In either case, have a set
number of hooks in each space for keys. When all of the hooks in an area are full, the space is full and no longer a choice.
• Have learner choose a preferred food item from the menu at a restaurant.
• Have learner choose the brand when purchasing a food item (e.g., peanut butter) at the grocery store.

8. Organization Skills: Organizes Time

GOAL: INCREASE ORGANIZATION OF TIME
SAMPLE OBJECTIVE: After receiving instructions, learner will initiate, attend to, and complete a familiar activity in an allotted
period of time during three of four observations.

ACTIVITY SUPPORTS AND STRATEGIES: One-to-one with adult

Contexts: Familiar, mastered, and motivating closed-ended activities with consistent routines
Materials: Motivating objects, digital clock, note cards, cut-up letters/puzzle, and manipulatives
Procedures:
• Establish consistent and predictable routines around familiar activities.
• Provide clear verbal directions along with visual supports for the activity.
• Have learner write down or verbalize the sequential steps (e.g., “First…then...”).
• Have learner mark off each completed step on a checklist to note progress.
• Define termination point or what needs to be done before activity is completed (e.g., complete five math problems).
• Use highly motivating activities to keep learner engaged (e.g., stickers of special interest on worksheet).
• Clarify length of time in which learner is expected to get started and remain engaged.
• Define time as a series of events rather than temporal units (e.g., minute).
• Use a digital clock and have learner create time note cards. Teach him or her that when the time on the card matches the time on the
clock, it is time to begin or end an activity.
• Have learner pull off a number (e.g., 3-2-1-done), add a letter to his or her name, or assemble a puzzle piece by piece to mark the passage
of a specific time period (e.g., 5 minutes). When all numbers have been taken off, the name is spelled, or the puzzle is completed, the task
is complete.
• Use a visual card that reads wait when it is not learner’s turn or he or she needs to wait. Give motivating reinforcement for every minute
engaged or waiting.
• Allow learner to hold or engage in activity with an object (e.g., toy or manipulative) when expected to wait.

ACTIVITY SUPPORTS AND STRATEGIES: Small group with one or more peers
Contexts: Familiar and mastered activities (start with closed-ended) with consistent routines
Materials: Visual supports (e.g., schedule, checklist), visual/auditory timer, chalk/white board, and carpet square
Procedures:
• Post a class schedule to visually reference.
• Provide a checklist of the steps it takes to accomplish an activity using technology, or write steps on chalk/white board.
• Use a task chart and cross off each item once it is completed so that group members are able to visually see how many things are left to

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 complete.
• Give a cue to begin an activity.
• Set a visual and/or auditory timer during activities and wait time.
• Give a verbal and visual direction of what comes next in an activity.
• Partner learner and peer to complete activity together.
• Place a carpet square, a designated chair, or a circle on the floor to designate where to stand in line when learner is expected to wait.

WAYS TO GENERALIZE SKILLS

• Have learner complete a sequence of activities designated “1-2-3-done” independently following pictographs of each sequential step.
Complete activities from folders or bins, with completed activities placed in a “done” location (e.g., basket).
• Have learner follow a sequence of events and expectations using a social script during an infrequent event e.g., holidays, vacations, doctor
visits). Practice any parts of the event that can be rehearsed beforehand (e.g., mock trick-or-treating, playing doctor).

9. Self-Regulation Skills: Transitions

GOAL: INCREASE SUCCESSFUL TRANSITIONS
SAMPLE OBJECTIVE: When directed, learner will stop activity and make a transition during three of four observed transitions.

ACTIVITY SUPPORTS AND STRATEGIES: One-to-one with adult

Contexts: Transition activities
Materials: Motivating and preferred transition objects, and visual supports (e.g., pictographs, written words, social narrative, First…then…)
Procedures:
• Clearly map out daily routine (e.g., sequence of activities) on a visual schedule using pictographs for nonreaders and written words for
readers.
• Create a consistent transition routine where learner takes picture off or makes a check mark on schedule when activity is completed.
• Define what comes next to prepare for transition.
• Place photographs, coupled with verbal directions, into a First…then… format with the more motivating and desired activity second.
• Create a repertoire of activities, objects, or prompts that remains consistent despite inconsistency in sequence or routine. For example,
activities may fluctuate, but breaks are always at the same time.
• Use consistent cues to forewarn transitions. Point at visual timer and say, “This activity will stop in 5 minutes.” Hold up five fingers to
reinforce what has been said.
• Find a motivating and/or comforting transition object that learner can carry between activities and places.
• Tell learner verbally and show visually to allow time to process unexpected changes that are known ahead of time (e.g., provide advance
warning about a substitute teacher).
• Write a social narrative about spontaneously occurring situations that disrupt daily routines (e.g., fire drills, snow days, illness, late bus,
Internet challenges).
• Come up with a phrase to say when unexpected changes occur (e.g., “Change is okay.”)

ACTIVITY SUPPORTS AND STRATEGIES: Small group with one or more peers
Contexts: Transition activities
Materials: Motivating and preferred transition objects, visual supports, and auditory stimulus
Procedures:
• Incorporate a transition routine between activities. For example, have group count or sing a song while they wait or transition to next
activity.
• Have group members return to a fixed location and go through established sequence of actions before moving on to the next activity.
• Teach individuals to stay in designated wait area until it is their turn or time for transition.
• Cue with a consistent auditory stimulus (e.g., bell, “all done” song, whistle, check schedule) to signal end of activity.
• Regularly talk to group members and remind them that unexpected changes could occur.
• Practice what unexpected changes might look and feel like.

WAYS TO GENERALIZE SKILLS

• Provide learner a home transportation visual that contains a photograph of the family member who will be picking him up from school to
prepare for transition from school to home.
• Provide learner photographs of destinations and places commonly visited when traveling to different destinations in the car.
• Provide learner an itinerary on paper or through technology during a community outing.

10. Self-Regulation Skills: Emotional Regulation

GOAL: INCREASE EMOTIONAL REGULATION
SAMPLE OBJECTIVE: With the use of visual supports, learner will monitor stress level and engage in a calming activity, as an
alternative to challenging behavior, in 80% of anxiety-provoking situations.

ACTIVITY SUPPORTS AND STRATEGIES: One-to-one with adult

Contexts: Frustrating, anxiety-provoking, or overstimulating sensory activities
Materials: Visual supports (e.g., pictographs, written words, social narratives), and sensory items
Procedures:
• Explain what stress looks like and feels like while learner is calm (e.g., state of equilibrium).
• Teach learner to monitor frustration level and identify increasing anxiety by using a visual support (e.g., curve, scale, zone, thermometer).

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 • Model and label self-regulation techniques (e.g., “I am feeling frustrated, so I am stretching”).
• Have a phrase to check in with learner (e.g., “Where are you on a scale of 1 to 3 with a 1 being calm and a 3 being frustrated?” “Is your
anxiety running low, just right, or high?”).
• Have learner experiment with a variety of techniques and create a list of identified calming strategies that work for him or her (e.g., three
to five deep breaths).
• Prompt learner to verbally request or use a break card to use quiet, spaces with calming items (e.g., sensory items, bean bag, rocking chair,
pillows, swing).
• Use antecedent-based interventions and reduce environmental stimuli. For example, restrict bright fluorescent lighting and busy wall
patterns, and use muted lighting and neutral colors.
• Allow learner to wear headsets or listen to white noise or preferred music.
• Simplify auditory input and language and use a clear, neutral vocal tone.
• Revert to gestural or pictographic cues when learner is overstimulated.
• Clarify options and refrain from question-and-answer exchanges when learner appears disorganized.
• Rely on simple comments and short directives to focus learner.
• Intersperse gross motor and physical activities throughout day.
• Provide learner with tactile input (e.g., squeeze stress balls, rub fabric pieces).
• Use social narratives and social decision making visual supports to help learner understand anxiety-provoking activities and alternatives to
challenging behaviors.

ACTIVITY SUPPORTS AND STRATEGIES: Small group with one or more peers
Contexts: Frustrating, anxiety-provoking, or overstimulating activities
Materials: Preferred objects and visual supports (e.g., pictographs/written words)
Procedures:
• Have peer use a break card and/or request a break when frustrated.
• Have peer prompt learner to pick a calming strategy when feeling anxious. For example, during a turn-taking game with peer, when
learner starts to feel frustrated, the peer will point to the break card or suggest a calming strategy such as “Let’s stand up, stretch, and take
a few deep breaths.”
• Have peer accompany learner in engaging in calming strategy.

WAYS TO GENERALIZE SKILLS

• Have learner select a calming tool from a list of previously taught calming strategies when feeling anxious during a large-group activity.
• Have learner take some deep breaths when feeling frustrated during a community activity.

DO-WATCH-LISTEN-SAY: Social and Communication Intervention for Autism Spectrum Disorder, Second Edition, by Kathleen Ann Quill and L.
Lynn Stansberry Brusnahan. Copyright © 2017 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

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SOCIAL SKILLS ACTIVITY SHEETS

1. Play and Leisure Skills: Solitary Play and Leisure

GOAL: INCREASE SOLITARY PLAY AND LEISURE
SAMPLE OBJECTIVE: During structured activities, learner will independently use play and leisure materials in a functional
manner in 80% of observations.

SAMPLE ACTIVITIES: One-to-one with adult

Contexts: Solitary play and leisure activities
Materials: Select preferred objects and materials that can be used in a conventional manner. Match materials and objects to learner’s
exploratory style, interests, and sensory preferences.
• If exploratory style is visual, teach to play with Lite-Brite or hand-held computer game.
• If exploratory style is auditory, teach to play a musical instrument or listen to audio.
• If exploratory style is tactile, teach to make playdough cookies or fill clear plastic vases with colored sand.
• If exploratory style is kinesthetic, teach to jump on the trampoline or play Hopscotch.
Procedures:
Activity Idea 1: Identify motivators that are matched to learner’s interests. Embed motivators within a novel object in an activity when learner
is resistant:
• If interested in Disney characters, teach learner to look at Disney books.
• If interested in trains, teach learner to put train tracks together for the train.
• If interested in a movie, use puzzles that contain pictures of favorite characters.
• If interested in running, teach learner to roller skate.
Activity Idea 2: Select activities that provide the same sensory feedback as self-stimulatory behaviors:
• If learner throws objects, teach to play bean bag toss or throw a basketball into the hoop.
• If learner spins objects, teach to spin a See ’n Say or do spin art.
• If learner spins him- or herself, teach to follow an exercise video or dance to music videos.
Activity Idea 3: Play with trains using organized materials and a clear sequence of steps embedded in the activity.
1. Organize a box with a few trains and track pieces. Place only the pieces the learner is expected to use in the box.
2. Organize activity so that there is a clear end point (e.g., closed-ended). For example, pair activity with a song. Sing or play a song
about trains, and time the activity so that it ends when the music ends.
3. Use modeling and prompting. For example, model connecting the train tracks. Repeat the sequence of steps until learner has mastered
the steps.
4. Use tangible or social reinforcement intermittently to sustain attention. For example, slowly add more train track pieces to extend the
track. When the track is together, hand learner his or her favorite train. Encourage learner to push the train around the track.
5. Systematically reduce prompts as learner’s independence increases during play.
6. Encourage learner to continue the activity independently in his or her own way.
Activity Idea 4: Building with Legos
• Build a Lego model based on learner’s interest. For instance, use learner’s interest in a favorite baseball team and build a model of a
baseball field.
• Use visual step-by-step directions.
• Fade adult assistance as independence increases.
• Increase length of time learner is expected to participate, using a visual timer to note the length of time he or she engages in activity.
Activity Idea 5: Have learner engage in a desirable art activity by coloring a picture of a boy or girl getting ready to go outside and play.
1. Color-code the outline of the mittens, coat, and boots in green, red, and black.
2. Prompt learner to follow the outline.
3. Gradually decrease the number of color-coded items to increase learner’s flexibility and creativity.

SAMPLE ACTIVITIES: Group with one or more peers

Solitary play and leisure activities can be accomplished near peers but do not require interaction with peers.

WAYS TO GENERALIZE SKILLS

• Art: Have learner put together dot-to-dot puzzles, trace using stencils, draw pictures with colored pencils, or use cookie cutters to create
playdough “pretend food.”
• Constructive: Have learner play with pop beads, set up train tracks, build Lego models, hit nails with a toy hammer, build a block tower, or
create structures with manipulatives.
• Dramatic: Have learner dress up using a script (e.g., choose character, gather clothing and accessories, dress in costume) or set table and wash
dishes in kitchen area.
• Exploratory: Have learner put parts on Mr. Potato Head, find magnetic letters in rice table, scoop plastic fish into a bucket at water table, or
use blocks as vehicles driving in sandbox.
• Games: Have learner play Lotto, ring toss, or Dominoes.
• Literacy: Have learner read or listen to books, act out a story using action figures, retell a favorite story into a recorder, or make words with
magnetic letters.
• Manipulatives: Have learner put together puzzles, assemble a multipiece model car from a picture, build Lego models, make crafts by
following a model, or make beaded jewelry.
• Music: Have learner listen to videos, follow a choreographed dance to a music video, use musical instruments to play along with a song, or
listen to Disney songs.
• Physical: Have learner ride a bicycle, roller skate, exercise using a video, play Hopscotch, play golf, follow an obstacle course, throw a ball
through a hoop, or play basketball.

2. Play and Leisure Skills: Social Play and Leisure–Structured

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 GOAL: INCREASE SOCIAL PLAY AND LEISURE—STRUCTURED
SAMPLE OBJECTIVE: During a structured small-group activity, learner will take turns with peers in three of four opportunities.

SAMPLE ACTIVITIES: One-to-one with adult

Begin and teach structured social play and leisure activities in a one-to-one situation with an adult. When a specific skill is mastered with an
adult, next teach the activity with one or two peers and the learner. When the skill is mastered with one or two partners, increase the number
of peers and the group size.

SAMPLE ACTIVITIES: Group with one or more peers

Contexts: Social structured play and leisure activities (e.g., computer station, turn-taking games, puzzles)
Materials: Computer, pictographs, board games, and two empty puzzle boards and with bin of pieces
Procedures:
Activity Idea 1: Use computer games to teach waiting and turn taking.
1. Arrange the technology station with two chairs. If using a computer, set up one mouse and two mouse pads.
2. Start the game on the technology being used.
3. Use a WAIT pictograph to indicate who is waiting to play. If using a computer, place the mouse on the pad of the person who will be
going first and a WAIT pictograph on the pad of the other person.
4. Place a visual timer that has audio where both learner and peer can see it.
5. Set the timer for 5 minutes and have the first person begin playing.
6. If the other person is having a hard time waiting, use simple language to remind him or her “It’s ________ ’s turn; you have to wait.”
Refer individual to the pictograph, or show him or her that the timer is moving.
7. When the bell rings, say, “_______’s turn is all done. Now it’s ________ ’s turn.”
8. Have individuals exchange pictographs, and reset timer for 5 minutes. If on a computer, have learner hand mouse to peer.
9. Leave and come back to reset timer once routine is familiar.
10. Prompt individuals to reset timer independently.
11. Adjust the time period to shorter or longer according to skill level.
12. Have a predetermined alternate method to clearly show termination of entire activity.
Activity Idea 2: Turn-taking game
1. If objective is predictable turn taking in a group game, arrange four chairs at a small table away from distractions.
2. Make three WAIT pictographs and one MY TURN pictograph.
3. Lay pictographs in front of each place at the table.
4. Use a visual of game’s directions to serve as a reminder to group.
5. Set up the game and call the game players to the table.
6. Have players pick up a pictograph. The person with the MY TURN pictograph goes first.
7. He or she uses the visual directions to take a turn. The first player then swaps the MY TURN pictograph for the WAIT pictograph of
the person sitting next to him.
8. Continue play until game is over.
Activity Idea 3: Puzzles
1. Place a chair on either side of a small table.
2. Put two empty puzzle boards in front of one chair and the puzzle pieces in front of the other chair.
3. Prompt learner to choose peer partner.
4. Encourage individual sitting in front of the puzzle pieces to give them to partner, one at a time, until the first puzzle is completed.
5. Have partner switch roles to complete second puzzle.

WAYS TO GENERALIZE SKILLS

Based on learner’s goals and objectives, promote generalization by selecting structured activities that
• Are already mastered by learner during solitary play and/or in a one-to-one setting
• Allow learner to play independently with his or her own set of materials beside an adult or peer
• Include parallel play that learner has demonstrated with shared materials
• Are closed-ended activities
• May or may not require sharing of materials
• Allow for, but do not require, observation and imitation
• Organize toys and materials to clarify when and how turn taking occurs
• Emphasize individual’s ability to nonverbally respond to others
• Limit requirements for verbal interaction
Structured play and leisure ideas include:
• Art: Have learner decorate a picture with own materials, take predictable turns with peer using playdough, decorate art project on own paper
while sharing markers, or add decoration to a large-group picture one at a time using a visual schedule of turns.
• Constructive: Have learner build with own blocks, take predictable turn pushing a train until it reaches destination and then allow peer to
push train back, share Legos and then return them to marked bin when finished, roll car back and forth to peers in a group for predetermined
time, or take turns with a group driving cars down a ramp.
• Dramatic: Have learner choose dress-up clothes for own bin, decorate cookie on own tray sharing frosting at a birthday party, use individual
toy (e.g., farm animals) at a shared area (e.g., barn), wear dress-up items from shared bin, or play grocery store and when finished return items
to designated location so another may use.
• Exploratory: Have learner use individual set of toys (e.g., bucket, shovel) at the water table or sand box, blow bubbles and then hand the
bubble wand and mix to peer, wind up a mechanical toy and then hand it to peer to wind up, or blow bubbles with a large bubble wand from a
bucket of mix shared with group.
• Games: Have learner play games such as Ring Around the Rosie or Hokey Pokey in unison; take turns playing games like KerPlunk, with
four individuals pulling the sticks out one at a time; or take turns following the musical pattern of the game Simon, switching turns when one
person makes a mistake and the game buzzes.
• Group time: Have learner respond with a group chorally to questions; recite a poem chorally; do finger plays in unison; use own calendar and
number stamps to imitate what teacher is doing; sit on own chair or carpet rug square marked by color, photograph, or name; or share a
microphone and say name before passing it to peer.

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• Literacy: Have learner read own book, respond chorally during book reading, use own set of story props from container, partner with peer to
turn pages, take turns retelling a story using a microphone, use own headphones with one audio book shared with peer, fill in blanks with a
group when reading a familiar story, or take turns in a group using a talking stick or going in order of seating arrangement.
• Manipulatives: Have learner sit at a colored place mat and complete a puzzle, use own bin of manipulatives for a math activity, search for Mr.
Potato Head body parts buried in shared rice table, or find individual puzzle pieces from a mix of pieces together in one shared bin.
• Music: Have learner sing or use musical instruments chorally; listen to audio or watch music videos together at same time; or use headsets to
listen to music in a bin marked with color, photograph, or name.
• Physical: Have learner shoot baskets with own basketball, play Follow the Leader, participate in activities (e.g., swimming) with group in
gym, push a partner on a swing for a predetermined number of pushes and then switch places, take turns with peer going down a slide,
alternate shooting a basketball with peer, play catch with a baseball, play with a group in a ball pit, or take turns following steps for an obstacle
course.

3. Play and Leisure Skills: Social Play and Leisure—Unstructured

GOAL: INCREASE SOCIAL PLAY AND LEISURE—
UNSTRUCTURED
SAMPLE OBJECTIVE: During unstructured (open-ended) play and leisure activities, learner will play cooperatively with peer in
three of four opportunities.

SAMPLE ACTIVITIES: One-to-one with adult

Begin and teach structured social play and leisure activities in a one-to-one situation with an adult. When a specific skill is mastered with an
adult, next teach the activity with one or two peers and the learner. When the skill is mastered with one or two partners, increase the number
of peers and the group size.

SAMPLE ACTIVITIES: Group with one or more peers

Contexts: Social unstructured play and leisure activities art activity, group game
Materials: Mural paper, paint, brushes, glitter, stickers, stencils, and visual supports
Procedures:
Activity Idea 1: Make a group mural
1. Tape a large piece of mural paper to a table.
2. Set out various art materials, such as paint, paintbrushes, markers, glitter, stickers, and stencils. Limit the number of each medium so
the group is required to share and take turns.
3. Have bowls of warm water or wet paper towels readily available for individuals who do not like to get their hands messy.
4. Give a smock to every person.
5. Assign or give a few ideas for a theme for the mural (e.g., St. Patrick’s Day, Spring, All About Me, The Farm).
6. Require group to share materials and work together to complete the mural.
7. Work on the mural until the predetermined end of activity (e.g., bell goes off, all materials used, paper filled) is reached.
8. Require group to work together to put away materials and clean up.
Activity Idea 2: Play a variation of Simon Says
1. Have group stand in a circle. Stand next to individuals who have weaker imitation skills or need help staying on task.
2. Have a DO pictograph to silently point to.
3. Have a child stand in the middle of the circle.
4. Explain to the group that the person in the middle of the circle is going to say and perform an action and they are to copy that person.
5. Further explain that when the person in the middle performs the action, everyone is to clap and cheer for him or her.
6. Substitute that learner’s own name for Simon and begin with ______ “says clap.” Perform the action as you are saying it.
7. Begin clapping and praising learner in the center when he or she performs the action.
8. Repeat with new action.
9. Have person in the middle switch with another person.
10. Continue until the predetermined end of the activity (e.g., five actions) is reached.
11. Vary complexity of the task from positional to movement or go from a single action to a sequence or pattern.
12. Allow each child to take turns being leader.

WAYS TO GENERALIZE SKILLS

Based on learner’s goals and objectives, promote generalization by selecting a range of cooperative activities that
• Are already mastered by learner during solitary play and/or in a one-to-one setting
• Include parallel play that has been demonstrated by learner with shared materials
• Are open-ended activities
• May require waiting, turn taking, and sharing of materials by everyone
• Allow learner to demonstrate the ability to observe and imitate
• Include a common focus on play and materials or engage learner in an activity with peers working toward a common goal
• Emphasize ability to nonverbally respond; may or may not have limited requirements for verbal interaction
• Require one or all of the following: Learner must understand what to DO, whom to WATCH, how to LISTEN, and how to respond
verbally or nonverbally to others (SAY)
Cooperative play and leisure ideas:
• Art: Have learner use playdough to make “food” for a class party with group, or create an art project with peer using one large piece of paper
and various shared art materials.
• Constructive: Have learner put train tracks together with peer, build a single car ramp from pieces with group, play Jenga game with group, or
work at tool bench to build something with group.
• Dramatic: Have learner act out role with peer using previously mastered scripts (e.g., grocery store cashier, shopper), reenact a story using
action figures with group, dress up as favorite characters and act out a familiar story with group, or put on a puppet show with group.
• Exploratory: Have learner take turns with peer pouring water over water wheel, participate in sand table scavenger hunt following treasure

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 map to find hidden items with group, or scoop plastic fish from water table with own net and put into own bucket at water table with group.
• Games: Have learner play two-person games such as Connect Four or Tic-Tac-Toe or play group games such as Uno, Old Maid, Twenty
Questions, Don’t Break the Ice, Ants in the Pants, Topple, Dominoes, and Lotto.
• Group time: Have learner sit with group in a circle to play game or play Hide-and-Seek, finding items teacher hid that he or she uses to
complete morning activities (e.g., attendance, calendar).
• Literacy: Have learner play Scrabble Jr. word game with group, use props to tell a story with group, compile a yearbook with group, present
report to class with peer, read shopping list at store and have peer collect items, or complete group cooking project using visual recipe.
• Manipulatives: Have learner work with peer to complete one floor puzzle, complete a giant floor puzzle with group, or share manipulatives to
complete math problems with peers.
• Music: Have learner play Musical Chairs with a group, participate in a group Hot Potato game with a beanbag, or play an instrument as part
of a marching band.
• Physical: Have learner kick a football held by peer, ride up and down on a seesaw with peer, participate in a group kickball game or relay races,
work together with group to flap a parachute and keep balls on top of it, or take the attendance sheet to the office every morning with peer.

4. Group Skills: Attends in Group

GOAL: INCREASE ATTENDING IN GROUP
SAMPLE OBJECTIVES: During a language-based group activity, learner will attend in a group for 5 minutes in three of four
opportunities.

ACTIVITY SUPPORTS AND STRATEGIES: One-to-one with adult

Group activities are accomplished with peers, but it is important to begin by teaching group activities in a one-to-one situation with an adult.
When this is mastered, teach the activity with one to two peer(s) and learner. When this is mastered, increase number of peers to a small
group. Attending during discussions is often challenging and requires the use of multiple organizational, social, communication, and
behavioral supports.

ACTIVITY SUPPORTS AND STRATEGIES: Group with one or more peers

Contexts: Meaningful language-based group activities
Materials: Visual supports
Procedures:
1. When preparing learner for a group activity, consider the following questions and arrange for needed organizational, social,
communication, and behavioral supports:
• Has learner mastered the group activity in a one-to-one setting?
• Does learner understand what to do and for how long in the group activity?
• Does learner understand the language used in the group?
• Does learner imitate peers in a group?
Organizational supports
• Organize space so learner clearly understands exactly where he or she needs to be.
• Organize materials so it is clear to learner exactly what he or she needs to use.
• Organize materials to clarify what is for personal use and what is shared.
• Organize materials to correspond with each step of specific activity.
• Organize activity so learner can clearly see what to do and for how long.
• Organize activity to clarify to learner when the activity is completed.
• Position learner so he or she can see the group leader (e.g., teacher).
Social supports
• Select a peer coach for learner to watch in order to see and remember what to do.
• Allow learner to be an active participant in the group (e.g., hand out or collect papers).
Communication supports
• Make a visual list of the group rules (e.g., watch, wait, listen, raise your hand, take turns).
• Provide a visual sequence of events for the activity.
• Use nonverbal attention-getting devices to refocus (e.g., whistling, a funny noise).
• Use a light pointer to keep learner focused on charts, pictures, or words.
• Use exaggerated facial expressions and rhythmic language when speaking.
• Use props to maintain attention (e.g., a funny hat, a clown nose).
• Instruct learner to look at whoever is wearing the colored ribbon or holding the “talking stick” or microphone.
Behavioral supports
• Plan antecedent-based modifications to address any restricted, repetitive, or challenging behaviors that could interfere with activity.
2. When providing support during a language-based group activity, consider the following strategies:
• Provide a group schedule of the activity. Place the schedule in the front of the room so the group leader can point (e.g., use a pointer)
to relevant information as directions are given during a structured group lesson in a classroom.
• Place an individual visual schedule of activity steps near learner.
• Establish a predictable routine for the beginning and end of discussion. Use a special It’s new! symbol to prepare learner for
unfamiliar routines.
• Ensure that the complexity of language matches learner’s comprehension abilities during activities that require listening in a group to
increase learner’s attending.
• Use pictures, graphics, and/or figures to highlight the information within the discussion or story. Present all language information
visually if needed.
• Use routine group directions (i.e., “Everybody, ________”) to get and maintain everyone’s attention.
• Verbally label each step of the activity.
• Build up longer periods of participation, with the goal that learner participates during the entire activity. Allow learner to leave the
group after participating for a short period if necessary.
• Create a video to preview new activities with learner and make an accompanying social script of the activity sequence. Show video to
learner a number of times prior to the activity. Try to use the exact or similar language and vocabulary in the video that will be

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 encountered in the group situation.
• Use cue cards to facilitate learner’s communication during his or her turn.
• Have learner choose a relevant topic to share with group during class discussions. Make written or pictographic cue cards with learner
to represent what he or she will say. Practice script several times in a one-to-one setting with learner.
• Make a visual chart of which peers will provide comments and in what order. Show the chart to learner before he or she joins the
group. Reference the chart to help learner prepare for his or her turn.
• Have each commenter hold a talking stick while it is his or her turn to talk. Prompt learner to watch whoever is holding the talking
stick.
• Have learner join a peer buddy in an activity. Have two to three peers wear a colorful ribbon on clothing. Learner can look for the
buddies who are wearing ribbons and join them.

WAYS TO GENERALIZE SKILLS

• Have learner remain in proximity to group until completion of a meal.
• Use concrete means to clarify length and completion of the activity. For example, include a time board with removable numbers (e.g., meal is
finished when all of the numbers are removed), a visual timer that rings when meal is finished, or other organizational supports to clarify time.

5. Group Skills: Takes Turns in Group

GOAL: INCREASE TURN TAKING IN GROUP
SAMPLE OBJECTIVE: During a group activity, learner will raise a hand to receive a turn in three of four opportunities.

ACTIVITY SUPPORTS AND STRATEGIES: One-to-one with adult

Group activities are accomplished with peers, but it is important to begin by teaching group activities in a one-to-one situation with an adult.
When this is mastered, teach the activity with one to two peers and learner. When this is mastered, increase the number of peers to a small
group.

ACTIVITY SUPPORTS AND STRATEGIES: Group with one or more peers

Contexts: Motivating and meaningful group activities
Materials: Preferred objects and visual supports
Procedures:
1. When preparing learner for group activity, consider the following questions and arrange for needed organizational, social,
communication, and behavioral supports:
• Has learner mastered the group activity in a one-to-one setting?
• Does learner understand what to do and for how long in the group activity?
• Does learner observe peers in a group? Does learner imitate peers in a group?
• Does learner understand the language used in the group?
• Does learner follow group attention-getting directions?
• Does the activity have an organized sequence of predictable steps?
• Does learner watch others taking a turn? Does learner demonstrate turn taking with adult?
• How can the activity be organized for more structure and organization?
Organizational supports
• Give learner a specific transition object to hold signifying he or she has to wait (e.g., in line).
• Use a timer to indicate the length of time to wait.
• Play music the entire time required for waiting.
• Designate a waiting chair for learner to sit in while waiting.
• Place footprints, numbers, or names on floor by door to assist with lining up.
• Give learner the role of door opener and/or holder.
• Have the group hold on to a rope when traveling in a line.
• Allow learner to be first or last in line.
• Pre-assign individual turns in order on a list.
• Base turn taking on the order in which the children are seated.
• Define the length of a turn by using a visual and/or an auditory timer.
• Define completion of a turn by the finished product (e.g., two ideas shared in discussion group, a paragraph read in a reading group,
a turn on the swing to the count of 50).
• Define completion of a turn by a countdown (i.e., “10, 9, 8…”).
Social supports
• Choose a peer coach for learner to watch and reference what to do.
• Assign a peer helper to assist learner.
• Have learner hold hand or be near one peer partner during a transition.
• Direct group to line up and place one hand on shoulder of peer in front of them.
• Pair learner with peer buddy during unstructured activities.
• Coach and provide reminders to peer models on how to help learner take turns.
• Coach and provide reminders to peer models on how to help learner understand what is said by using familiar routine phrases.
Communication supports
• Use a portable cue card that specifies “First… then...” (e.g., photo of next activity).
• Make a list or individual cue cards that specify group rules (e.g., watch, wait, listen, raise hand, take turns).
• Preview and review a social narrative about group rules.
• Generate a list of simple routine carrier phrases to use consistently in specified group situations, such as “It’s time to ________ ,”
“Look up here,” “Clean up,” “Everybody…,” “Get ready,” “Boys and girls…,” or “It’s time to listen.”
• Pair transition phrases with exaggerated gestures and an animated tone of voice.
• Use a routine song to get group’s attention to line up or transition.
• Use a visual chart to specify whose turn it is and who is next.

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 • Have the individual hold a WAIT cue card when it is not his or her turn.
• Have the individual hold a MY TURN cue card when it is his or her turn.
• Write a social narrative about taking turns.
Behavioral supports
• Plan antecedent-based modifications to address any restricted, repetitive, or challenging behaviors that could interfere with activity.
2. When providing support during a group activity, consider the following strategies:
• Provide a visual cue rule card that states the rule, raise your hand to get a turn. The teacher can wear a cue card around his or her neck
or tape a cue card on each student’s desk.
• Praise each child for raising his or her hand every time you call on a person and point to the pictograph of hand raising. Do not give
attention to any individual who calls out without raising his or her hand, but point to the pictograph of hand raising. Have another
adult or peer prompt learner to raise his or her hand, if needed. Immediately call on and praise learner while pointing to the
pictograph when he or she raises a hand.
• Make a visual time board with symbols for WAIT and one symbol for MY TURN during times when learner is required to sit or
wait. Show learner, point, and say, “Wait, wait, wait, turn.”
• Place the visual support in front of learner as he or she sits with group. Remove first WAIT symbol after a predetermined amount of
time, and point and say, “Wait, wait, turn.” Repeat in this manner until all the waiting symbols are removed. Then allow learner to
raise his or her hand for a turn. Initially keep time between the removal of pictographs very short. Gradually lengthen time between
removal and time sitting with group.
• Preview social script about rules and turn taking.

WAYS TO GENERALIZE SKILLS

• Use predictable, routine phrases (e.g., “It’s time to ________.”) learned in one-to-one situations during group activities that require random
turn taking.
• Consistently use clear carrier phrases to get the group’s attention and direct actions across multiple group activities.
• Pair transitions within different types of group discussion with familiar nonverbal cues (e.g., clapping hands) or visual cues (e.g., a red flag).
• Use cue card to preview group activities that require raising one’s hand for a turn and those group activities that do not require raising hand for
a turn (e.g., recess, assembly).

6. Group Skills: Follows Group Directions

GOAL: INCREASE FOLLOWING DIRECTIONS IN GROUP
SAMPLE OBJECTIVE: During a familiar group activity, learner will follow routine group directions in three of four opportunities.

ACTIVITY SUPPORTS AND STRATEGIES: One-to-one with adult

Group activities are accomplished with peers. Begin and teach group activities in a one-to-one situation with an adult. When this is
mastered, teach the activity with one to two peers and learner. When this is mastered, increase the number of peers to a small group.

ACTIVITY SUPPORTS AND STRATEGIES: Small group with one or more peers
Contexts: Motivating and meaningful group activities
Materials: Visual supports
Procedures:
1. When preparing learner for a group activity, consider the following questions and arrange for needed organizational, social,
communication, and behavioral supports:
• Does learner demonstrate attending skills (e.g., attend to the adult) in the group?
• Does learner follow the directions (nonverbal and/or verbal) in a one-to-one situation?
• Does learner understand the directions (nonverbal and/or verbal) used in the group?
• Does learner follow the lead of peers when confused?
• Is learner comfortable in the new setting?
Organizational supports
• Provide visual cue (e.g., turn the lights on and off).
• Provide auditory cue (e.g., ring a timer or bell, clap or snap to a rhythmic beat).
• Provide gestural cue (e.g., have group raise their hands or put a finger to their lips).
• Use activity schedules that depict the sequence of events.
• Organize materials to clarify what is needed for each step of the activity.
• Allow learner to carry an object that he associates with comfort.
• Use a video to preview novel contexts.
Social supports
• Provide peer coach for learner to watch in order to reference what to do.
• Assign peer partner to assist learner.
• Have learner practice responding to the carrier phrase in an activity with peer.
Communication supports
• Use similar nonverbal group and attention-getting group directions throughout the day.
• Use exaggerated gestures and an animated tone of voice.
• Increase the use of explicit nonverbal gestural cues.
• Make a visual list of the group rules (e.g., watch, wait, listen). Cue the group as needed.
• Provide individual cue cards that specify the group rules.
• Preview and review a social narrative or story about group rules and following directions.
• Before giving directions, use a list of simple routine carrier phrases to use consistently in specified group situations, such as “It’s time
to ________ ,” “Look up here,” “Clean up,” “Everybody…,” “Get ready,” “Boys and girls…,” or “It’s time to listen.”
• Count before giving a direction (e.g., count to 3).
• Limit the complexity of verbal directions.
• Wait a few seconds before repeating directions.

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 Behavioral supports
• Plan antecedent-based modifications to address any restricted, repetitive, or challenging behaviors that could interfere with activity.
2. When providing support during a group activity, consider the following strategies:
• Design a social narrative or story about following group directions. The story should describe one or more types of nonverbal
directions and explain what to do. For example, it is time to stop and look at the teacher when the lights flick on and off. Read the
story to the class several times a day.
• Silently flick the lights whenever it is time to give group directions. Wait for all of the group to stop what they are doing and look at
you before giving any verbal directions. Have another adult silently stop peers and point them in your direction if the group does not
stop. Fade the silent, physical prompting as soon as possible.
• Use predictable, routine phrases that learner understands in one-to-one situations to get learner’s attention and increase learner’s
ability to follow group directions. Use these phrases consistently during the group activity. For example, clearly state “It’s time to line
up,” “Everybody, stand up,” “Come here,” or “Boys and girls, ________.”
• Teach group directions in a fun game. Begin by playing Simon Says as a structured small-group game. Then use it in the classroom
at random times, saying, “Simon says, ‘Put your hands on your head.’” Praise those who follow the direction, and prompt those who
do not. Once the group begin responding consistently, use “Simon says” as a means to get the group’s attention in natural contexts,
such as “Simon says, ‘Go to the reading area.’” Use silent prompting by another adult when necessary.
• Pair routine verbal directions with nonverbal cues (e.g., clapping hands) or visual cues (e.g., a red flag).
• Create an activity schedule or chart that depicts the sequence of steps to be completed to increase learner’s ability to follow verbal
directions during a familiar group activity. Place one activity schedule at the front of the room for the entire group, and give a second
copy to learner. Prompt learner to refer to the activity schedule if unclear about the teacher’s instructions during the activity.

WAYS TO GENERALIZE SKILLS

Note that new activities are often challenging for individuals with autism and require the use of multiple organizational, social, communication,
and behavioral supports. To teach a learner with autism to follow directions in novel group settings or activities, consider the following supports
and strategies:
• Have learner follow verbal directions by referencing a peer buddy who is wearing a colored ribbon (i.e., a concrete cue) during a novel group
activity. Teach learner to first look for and imitate his or her peer. Prompt learner to do what the peer does.
• Use familiar verbal directions when learner is in a new setting. In each new group activity, begin group instructions with carrier phrases such
as “Everyone, ________.”
• Be sure learner has had ample practice listening for routine phrases in familiar contexts.
• Prompt learner nonverbally with cue cards that list the group rules for following routine phrases and imitating peer. Use the cue cards every
time learner needs support during the novel activity.

7. Social Perspective-Taking Skills: Emotional Understanding

GOAL: INCREASE EMOTIONAL UNDERSTANDING
SAMPLE OBJECTIVE: When shown images of various facial expressions, learner will identify common emotions in others in
three of four opportunities.

SAMPLE ACTIVITIES: One-to-one with adult

Contexts: Social play and leisure activities
Materials: Preferred technology, mirror, flash cards, and video scenarios
Procedures:
Activity Idea 1: Assess emotions (e.g., happy/joy, sad, mad/angry, fear/afraid/nervous, excited, disgusted, surprised, tired, unfriendly, kind,
sorry, proud, jealous, joking, calm/relaxed, confused, ashamed) learner can currently identify and target emotions to teach. Then have
learner do an emotional recognition activity utilizing technology or flash cards.
Activity Idea 2: Sit next to learner in front of a mirror. Make facial expressions and label the emotions. Draw his or her attention to your face.
You may need to bring his or her hands to your face, add a sound, or use a picture cue. Make a sad face. Prompt learner to make the same
face. Once he or she makes the face, then switch your face to a happy face. Switch back and forth between happy and sad faces,
prompting as needed. Continue adding novel emotions as skills are mastered.
Activity Idea 3: Teach the facial expressions of mad and sad by adding motor movements to the facial expression. Show a mad face to learner
and add on the motor movement of stomping feet. Once he or she imitates the same movement and facial expression, switch to sad with
head looking down. For emotions like excited, jump up and down.
Activity Idea 4: Show video clips that illustrate common emotions. Pause the clip and have learner identify the emotion. Or, watch a video
that learner enjoys. Pause the video throughout to focus on a character’s face as he or she experiences different emotions. Point out the
different facial features that show each emotion.
Activity Idea 5: Find pictures of a preferred cartoon character showing different emotions. Point out the specific differences in the character’s
face to learner and explain what emotion the cartoon is feeling. Start to link emotions to feelings through modeling.
Activity Idea 6: Model emotions and think out loud to define the emotion for learner. Say, “Today I feel tired because I did not sleep well.”
Use other examples with different emotions.
Activity Idea 7: Reference others to teach emotions. “John looks sad because he fell down and hurt his knee.” Encourage learner to ask John if
he needs help.
Activity Idea 8: Provide scenarios and have learner identify feelings and how to respond to individuals experiencing an array of emotions.
Activity Idea 9: Take pictures of a familiar person in learner’s life (e.g., teacher, peer, sibling, parent) showing different emotions. Talk about
the different expressions and how each aspect of the face shows a specific emotion.
Activity Idea 10: Play a game with learner with pictures of familiar people showing different emotions. Have a staff member model making
the same facial expressions as the cards. Have learner find the matching card to the staff member’s face.
Activity Idea 11: Create pictures of different items such as spiders, snakes, ice cream cones, lightning, books, and trains as well as different
emotion pictures that learner can already correctly identify. Work with learner to pair up the item pictures with the emotion pictures. As
learner improves his or her abilities at this activity, add a verbal component, teaching learner to respond to the phrase, “If this happens,
then I feel like ______.”
Activity Idea 12: Create a game board with question mark squares. When learner lands on a question mark place, he or she picks up a card.

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 The card has a scenario on it, such as How do you feel when you fall down and scrape your knee? Encourage learner to say, “When I fall down
and scrape my knee, I feel sad.”
Activity Idea 13: Do a simple task that learner enjoys doing, but do it poorly and ask for help. For example, try to put a train on the tracks,
but instead pretend you can’t and demonstrate on your face that you are feeling frustrated. Turn to learner and ask for help. After doing
this activity a few times, move on to a different task that might be less preferred or a little bit more difficult. If learner does not offer to
help, have a different staff member prompt learner by saying, “I wonder what we could do for …? She seems frustrated.”
Activity Idea 14: Create a story together about different things happening to people that make a person feel sad, happy, angry, hurt, and sick.
Have learner be the hero of the story and respond to the person’s feeling to help him or her feel better.
Activity Idea 15: Create picture cards of different ways people feel and different things learner could do to make a person feel better. Have
him or her match the two sets of pictures.

SAMPLE ACTIVITIES: Small group with one or more peers

Contexts: Motivating and meaningful group activities and games
Materials: Video, worksheet, photographs, and board game
Procedures:
Activity Idea 1: Have all students check in at the beginning of an activity by putting their name on what emotion they are experiencing on the
emotion poster on the wall. Go around in a circle and have all children verbally state why they are experiencing the emotion they selected.
Activity Idea 2: Read a story in which the characters experience a variety of emotions. Stop throughout the story and identify the emotions.
Activity Idea 3: Pair learner with peer and have partners complete an emotion worksheet collaboratively.
Activity Idea 4: Have learner and peers brainstorm a list of 10 times a peer might need their help and what they could do to help.
Activity Idea 5: Have learner and peers complete a “match the scenario to the emotion” activity.
Activity Idea 6: Allow participants to play a turn-taking Feelings board game.
Activity Idea 7: Create cards for a game of Go Fish with different emotional expressions on the cards. Instead of asking for a specific card,
the group needs to make the face of the card they want. For example, if an individual is asking learner for a sad face card, he or she must
make a sad face.
Activity Idea 8: Play a game similar to Follow the Leader. Make different emotional faces instead of doing motor movements. Have the
group make the same face as the leader. Switch leaders so different individuals receive a turn.
Activity Idea 9: Create masks of different cartoon characters showing a variety of emotions. Play a game where learner takes turns with peers
putting on different masks and labeling the emotions.
Activity Idea 10: Create a modified Bingo board made with different pictures of characters’ emotions that will occur during a movie. Have
the group mark off the emotions on their board as the video plays.
Activity Idea 11: Play a modified Charades game with a group. Have each participant come up one at a time and show a different emotional
face. Encourage the group to name the emotion.
Activity Idea 12: Play a game in which a team needs to move water from one large container to another using small cups. Have one person
start the activity on his or her own. Have the person show through an emotion that he or she would like help to be able to move the water
faster.
Activity Idea 13: Explain to learner and peers that they are going to be detectives today at school. Explain that their job is to watch others
and see when they need help. Talk about what a person’s face looks like when he or she is frustrated and discuss specific times when a
person might need help (e.g., lifting something heavy, opening a door, putting something together). Throughout the day, prompt peers to
help one another by using a secret word/hand motion or saying “be a detective.” Fade the prompt as learner grows in his or her ability to
help others.
Activity Idea 14: Create a role-playing game where one person acts out a scenario in which he or she would feel sad, happy, angry, hurt, or
sick. Have learner with autism act out how to respond to that person’s feelings.

WAYS TO GENERALIZE SKILLS

• Generalize skills learned in the one-to-one setting in a small-group environment. For example, if learner can tell you that a loud noise makes
him or her feel scared, see if learner can give the same information when a loud noise happens in a group setting.
• Have learner identify peer’s feelings (e.g., “Clara is smiling because she’s happy to see her mother.”) when peer is experiencing various
emotions.
• Have learner use perspective taking (e.g., “Look at Joe’s face; he doesn’t like that.”) skills to identify the other person’s emotions when
someone does not like something.
• Talk about different things that are happening and how a variety of events make peers feel throughout the day. For example, “When your
friend lost the game, how did he feel?”
• Consistently acknowledge feelings (e.g., “You pushed that away because you don’t like it”) when learner is experiencing an emotion.

8. Social Perspective-Taking Skills: Friendships

GOAL: INCREASE FRIENDSHIP SKILLS
SAMPLE OBJECTIVE: When prompted, learner will invite peer to join his/her activity in three of four opportunities.

SAMPLE ACTIVITIES: One-to-one with adult

Begin and teach specific skills in one-to-one interactions with an adult. When the skill is mastered during various social play and leisure
activities with adults, practice the skill during the same activities with one or two peers and the learners. When the skill is mastered with one
or two peer partners, increase the number of peers engaged in each play and leisure activity. Social relationships and friendships are meant to
emerge from shared, mutually enjoyed activities.

SAMPLE ACTIVITIES: Small group with one or more peers

Contexts: Motivating and meaningful social play and leisure activities
Materials: Preferred objects, visual supports
Procedures:
Activity Idea 1: Play a greeting game where everyone in the group takes a turn going around the circle and says “Hello.” Every time peer

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 successfully greets everyone, cheer for the person. After learner has watched one or two other people take a turn, then have him or her go
around the circle greeting peers.
Activity Idea 2: Provide activities that are motivating to learner during a free play time period. Have learner watch the other peers begin to
play and then ask learner, “Where would you like to play?” Have learner go to the activity area chosen and prompt learner to ask peer to
play by using words, a picture card, or a sign. Continue to prompt learner to allow peers to join. Prompt learner to verbally say, “Yes,”
shake his or her head yes, motion for the peer to join, or give a picture card to the peer. Fade prompts as learner becomes more successful.
Add new activities and help learner begin to generalize the skill when he or she has mastered allowing peers to join in one activity.
Activity Idea 3: Start a game of Tag with a group. Have learner watch the group play for a while and then encourage him or her to join the
game. Prompt learner to ask, “Can I play?” and then prompt him or her to join the game. Fade prompts as learner becomes more
independent in joining in the game.
Activity Idea 4: Set up an activity in which learner and peer build with Legos or blocks. Have learner with autism place a block and then have
peer place a block. Establish a turn-taking routine between the two of them.
Activity Idea 5: Have learner draw a picture together with peer. Encourage them to talk to each other about what they are drawing.
Activity Idea 6: Have learner and peer write a story together. They can take turns coming up with what happens on each page or for each
sentence, whatever works best for the activity.
Activity Idea 7: Teach learner who inappropriately touches or seeks sensory input to ask peers for a high five. Have peer give learner with
autism a high five when learner asks, “Can I have a high five?”

WAYS TO GENERALIZE SKILLS

• Encourage learner to allow peer to join in play during a variety of activities that he or she enjoys (perhaps not one that is a specific interest and
would be hard to share with others).

DO-WATCH-LISTEN-SAY: Social and Communication Intervention for Autism Spectrum Disorder, Second Edition, by Kathleen Ann Quill and L.
Lynn Stansberry Brusnahan. Copyright © 2017 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

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COMMUNICATION SKILLS ACTIVITY SHEETS

1. Basic Communication Skills: Makes Requests

GOAL: INCREASE REQUESTS
SAMPLE OBJECTIVE: When finished, learner will make a request to be done by means of ________ (specify means of
communication) in 80% of targeted opportunities.

SAMPLE MEANS OF COMMUNICATION

• Communicative gestures: Physical proximity, looking at person/object, reaching, moving person/object (e.g., toward, away, pull, push),
reaching for object, or pointing (e.g., contact or distal)
• Emerging: Vocalization, speech, signs, photographs, pictographs, voice output system, or written language to convey simple message (e.g.,
done, give, want)
• Verbal: Speech, sign language, photographs, pictographs, voice output system, or written language to convey a multiword message (e.g., I
am done; I want ________)

SAMPLE ACTIVITY: One-to-one with adult

Contexts: Activities that include motivation to request
Materials: Preferred objects, beads, containers, string, mat, marbles, visual supports (e.g., I am done. I want ________), and augmentative
and alternative communication (AAC) as needed
Procedures:
1. Organize materials. Place four beads into a container. Place one bead and one string on the left side of the table and have a place to put
the finished product on the right. Place a visual icon for “I want ________” and “finished” in the workspace. Use a placemat to mark
the work area.
2. Model stringing a bead. Prompt learner to string his or her first bead. Then have learner make a request for the container of beads.
3. Maintain close proximity by sitting across from learner with your own set of materials. When five beads are on your string, say, “I’m all
done.” String beads, timing your completion to be simultaneous with learner’s completion.
4. Point to the visual icon, prompting learner as needed to imitate/communicate a request to be finished. Decrease the number of prompts
as appropriate.
5. Respond verbally to his or her communication that learner is finished: “That’s terrific. You want to be all done.” Gradually fade verbal
model, using visual icon to prompt communication.
6. Gradually stop and wait for learner to communicate all done when the string of beads is finished. Reward any means of communication.
7. Repeat the procedure for other types of activities. Repeat the sequence many times in the same manner.
8. To expand on this skill, allow learner to place a marble in a run and watch it go down for reinforcement. Use exaggerated facial
expressions, sound effects, tone of voice, and animation to make interaction fun. Emphasize the words you want the individual to learn
(e.g., say “more” instead of “more marble”). Verbally say “more” and sign MORE every time you place the marble down the run. Have
learner request item before giving him or her another marble.

SAMPLE ACTIVITY: Group activity with one or more peers

Contexts: Recess and free-time play and leisure activities that include motivation to request
Materials: Visual support (icon “all done”) and AAC as needed
Procedures:
1. Play Simon Says with peers. Have learner, peer, and adult take turns as the lead. Use a timer or sound signal to indicate that the leader’s
turn is finished.
2. Model saying, “I’m all done” to signal that it is the next person’s turn. Pair spoken language with signed, gestural, or pictographic cues
as needed.
3. Wait and watch for learner to communicate “All done” after his or her turn.
4. Rotate the Simon Says leader so that learner has multiple opportunities to practice the skill. Reward communication through group
applause. Have peer prompt learner if he or she does not respond as appropriate.
5. Repeat sequence many times in same manner.
6. Decrease the number of prompts over time.

WAYS TO GENERALIZE SKILLS

• Have learner request to end activity during daily living skill (e.g., brushing teeth, eating meal, end of haircut).
• Have learner request time on the computer at completion of task (e.g., read last page of a book).
• Have learner request more pushes when swinging on a swing at the playground.
• Have learner request help during an academic task or a nonpreferred activity (e.g., math worksheet).
• Have learner request a preferred food or drink when eating at a restaurant.
• Have learner request a stamp to mail a postcard on vacation.
• Have learner request help plugging in the computer when wanting to use a computer.

2. Basic Communication Skills: Basic Responses

GOAL: INCREASE BASIC RESPONSES
SAMPLE OBJECTIVE: When presented with an object that learner does not want, learner will spontaneously communicate “no”
by means of ______ (specify means of communication) in 80% of presented opportunities.

SAMPLE MEANS OF COMMUNICATION

• Communicative gestures: Physical proximity, looking at person/object, reaching, moving person/object (e.g., toward, away, pull, push),
giving objects, pointing (e.g., contact), shaking/nodding head, or waving

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 • Emerging: Vocalization, speech, signs, photographs, pictographs, voice output system, or written language to convey a simple message
(e.g., huh, yeah, no, sure, okay)
• Verbal: Speech, sign language, photographs, pictographs, voice output system, or written language to convey a multiword message (e.g.,
What’s up? I want, I don’t want)

SAMPLE ACTIVITY: One-to-one with adult

Contexts: Natural and structured interaction opportunities that include motivation to respond
Materials: Motivating objects (e.g., favorite books), visual supports, and augmentative and alternative communication (AAC) as needed
Procedures:
1. Place learner’s favorite books on a shelf that is within sight but out of reach.
2. Say learner’s name and prompt if he or she does not respond verbally. Ask, “What do you want?” Pair spoken language with signed,
gestural, or pictographic cues as needed.
3. Wait for learner to request a book.
4. Respond immediately to the request, but hand learner a completely irrelevant and uninteresting book.
5. Wait and watch for learner to refuse the book.
6. Prompt learner as appropriate to refuse the book if he or she does not respond. Exaggerate the refusal with facial expressions and tone
of voice.
7. Immediately give the preferred book to learner when he or she refuses.
8. Repeat sequence many times in same manner.
9. Decrease the number of prompts as appropriate.

SAMPLE ACTIVITY: Group with one or more peers

Contexts: Natural and structured interaction opportunities that include motivation to respond
Materials: Preferred games (e.g., Lotto board), visual supports, and AAC as needed
Procedures:
1. Play Lotto game with a small group. Use Lotto boards that are motivating for the targeted learner (e.g., animals, vehicles).
2. Call learner’s name. Wait and watch for learner to respond.
3. If learner does not respond, have peer prompt as appropriate.
4. Ask, “What do you want?”
5. Have peer respond immediately and provide learner the correct picture from the Lotto game once learner makes a choice.
6. Next, have peer provide a picture that learner did not ask for that is completely unrelated to anything on his or her board. Wait and
watch for learner to refuse the card. Have peer prompt if learner does not respond.
7. Once learner communicates refusal, take the incorrect picture back and immediately hand learner a correct picture.
8. Keep the game fun by exaggerating facial expressions and tone of voice.
9. Monitor learner’s level of frustration and be sure to alternate presenting incorrect cards with cards that match his board.
10. Repeat sequence many times in the same manner.
11. Decrease the number of prompts as appropriate.

WAYS TO GENERALIZE SKILLS

• Have learner respond to a greeting in the community at a shopping mall when his or her name is called.
• Have learner refuse when handed a spoon when he or she is waiting for a drink.
• Have learner refuse when handed the wrong jacket or backpack at the end of the school day.
• Have learner refuse when handed an object that is not related to his preference.
• Have learner respond with favorite song choice when asked to request music.
• Have learner agree to walk to school when his or her bicycle has a flat tire.

3. Basic Communication Skills: Answers Questions

GOAL: INCREASE ANSWERING QUESTIONS
SAMPLE OBJECTIVE: When adult asks a question (What is your name? Where do you live? How old are you?), learner will answer
by means of ______ (specify means of communication) during three of four opportunities.

SAMPLE MEANS OF COMMUNICATION

• Communicative gestures: Hand person card with personal information
• Emerging: Vocalization, speech, signs, photographs, pictographs, voice output system, or written language to respond to questions
• Verbal: Speech, signs, photographs, pictographs, voice output system, or written language to convey a multiword message such as I live on
(street name) street

SAMPLE ACTIVITY: One-to-one with adult

Contexts: Structured and natural opportunities where learner is motivated to respond and answer questions
Materials: Visual supports (e.g., cards posing questions and answers such as What is your name? Where do you live? Yes, No; color cards with
one color for questions and one for correct responses), augmentative and alternative communication (AAC) as needed
Procedures:
1. Allow learner to choose motivating reinforcement.
2. Set up a 1-2-3-done board that lets learner know he or she needs to answer three questions before being reinforced. Increase or
decrease this number as is appropriate for learner with autism.
3. Ask learner a question. Pair spoken language with signed, gestural, or pictographic cues as needed.
4. Wait and watch for learner to respond.
5. Prompt learner as appropriate to answer the personal questions if he or she does not respond. Decrease the number of prompts as
appropriate.
6. Repeat many times in the same manner. Watch level of frustration.

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 7. Provide breaks that are motivating.
8. Use a visual with who, what, when, where, and why on it. Allow learner to point at and choose the type of question.
9. Mark off the question type after it is chosen and require another type of question next.

SAMPLE ACTIVITY: Group with one or more peers

Contexts: Social and group opportunities where learner is motivated to respond and answer questions
Materials: Video of a basic interview, pretend microphone, props, visual supports, and AAC as needed
Procedures:
Have learner with autism and peer participate in an interview. Begin by watching a video of a basic interview. Point out that one person asks
questions and the other person answers them. Use color-coded question and response cards. Give peer the question cards and learner the
appropriate response cards. Have peer ask questions of learner with autism:
1. Have peer start by saying learner’s name.
2. Have learner respond.
3. Have peer greet learner.
4. Have learner respond to the greeting.
5. Have peer ask the first question: “What’s your name?”
6. Provide a variety of questions such as basic yes/no questions as well as who, what, when, where, and why questions. Ask questions where
learner must agree or disagree and state likes and dislikes.
7. Wait and watch for learner to answer questions.
8. Prompt learner to answer the questions if he or she does not respond. Decrease the number of prompts as appropriate.
9. Repeat many times in the same manner. Have learner with autism practice as many times as needed, decreasing prompts when
appropriate.
10. Reinforce learner with tokens for appropriate responses. Have learner pick a motivating activity to engage in after he or she answers or
asks a designated number of questions.
11. During the interview, pair spoken language with signs, gestures, or pictographs as needed.
12. To make the game fun, have participants hold a pretend microphone and involve interesting props.
13. Record a video of the interview between the learner and peer, then have them watch themselves.

WAYS TO GENERALIZE SKILLS

• Have learner respond to questions from a variety of school staff across the school day (e.g., teachers, nurse, bus driver, cafeteria lunch staff).
• Have learner respond to a question from a police officer.
• Have learner respond “yes” when offered a preferred item such as candy for reinforcement.
• Have learner respond to personal questions while talking on the phone to grandma (e.g., who, what, when).
• Have learner answer where he or she is going and with whom at the end of the school day.
• Have learner respond with answer when asked, “When is your piano recital?”
• Have learner respond, “It might rain” when asked, “Why did you bring a raincoat today?”

4. Basic Communication Skills: Comments

GOAL: INCREASE COMMENTING
SAMPLE OBJECTIVE: Using a visual depicting multiple activities, learner will comment about recently completed activities (e.g.,
I ate a burger for lunch) in 80% of presented opportunities.

SAMPLE MEANS OF COMMUNICATION

• Communicative gestures: Physical proximity, looking at person, shaking/nodding head, waving, shrugging, pointing (e.g., contact or
distal), reaching, touching self, or moving people/objects (e.g., toward, away, pull, push)
• Emerging: Vocalization, speech, signs, photographs, pictographs, voice output system, or written language to convey a simple message
(e.g., uh-oh, mine, in, color, event name)
• Verbal: Speech, sign language, photographs, pictographs, voice output system, or written language to convey a multiword message (e.g., I
played with blocks, I ate breakfast with Dad)

SAMPLE ACTIVITIES: One-to-one with adult

Contexts: Classroom and daily school activities that include motivation to comment
Materials: Summary sheet with a yes and a no beside each daily activity or augmentative and alternative communication (AAC) as needed
Procedures:
Activity Idea 1: Walk and say, “We are walking.” Ask learner, “What are we doing?” Prompt learner to describe his or her actions. Jump and
say, “I am jumping.” Prompt learner to jump, and wait for learner to describe his or her actions.
Activity Idea 2: Point at learner’s coat and ask, “What are you wearing?” Pair spoken language with signed, gestural, or pictographic cues as
needed. Wait and watch for learner to respond, “coat.” Ask, “Whose coat is that?” Wait and watch for learner to respond, “mine.” Model
language as you take off your coat: “I am taking off my coat.” Wait for learner to describe the action. Prompt him or her as necessary.
Drop your coat on the floor. Wait to give learner time to comment. Say, “oops” to direct attention to your coat on the floor as needed.
Prompt learner to comment as necessary.
Activity Idea 3: Go over a familiar daily schedule. Announce unexpected changes when these events occur. Say, “Uh-oh, music teacher is
sick” and place “uh-oh” card on schedule where music is scheduled. Have learner say, “Uh-oh.” Prompt as necessary.
Activity Idea 4: Have learner complete a summary sheet at the end of day. Have learner identify each activity and indicate (circle yes or no)
whether he or she participated in it that day. Have learner describe the activity or event (e.g., with whom he or she played, what he or she
made) in the space provided, using some visual multiple-choice options if the answer is yes. Prompt as necessary. Send copy of sheet home
so learner can tell his or her family about the day’s events. Repeat daily in same manner, decreasing prompts as appropriate.

SAMPLE ACTIVITIES: Group with one or more peers

Contexts: Classroom and daily school activities that include motivation to comment

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 Materials: Variety of motivating games, visual supports, or AAC as needed
Procedures:
Activity Idea 1: Label chairs with names. Have each learner find his or her chair, sit down, and say, “This is mine.”
Activity Idea 2: Show group a funny video. Model making comments on unexpected funny moments (e.g., “Oops”).
Activity Idea 3: Have each learner choose a partner and then have the pair ask each other a set of questions listed on the wall (e.g. “What did
you do this weekend? Did you go anywhere? Where did you go? Whom were you with?”). Provide a visual that shows multiple choice
options to answer questions.
Activity Idea 4: Take a picture or video of learner and his or her peers completing a variety of actions. Show learners the photograph or video.
Have each person comment on what peers are doing in the video. Prompt as necessary by asking, “What did ________ do?” after the
performance of each action. Pair spoken language with signed, gestural, or pictographic cues as needed. Wait for learners to describe
action: “(Name) is (action)” and “(Name) is under (item).” Decrease number of prompts as appropriate.

WAYS TO GENERALIZE SKILLS

• Have learner comment “oh-no” when handed the wrong lunch.
• Have learner name food items on grocery list when going to the grocery store.
• Have learner respond, “That is mine” when someone holds up an item and asks, “Who does this belong to?”
• Have learner relate what has been done at home during group meetings with time for sharing news.
• Have learner name familiar people and describe past events using photographs of family members and favorite activities (e.g., going to the
park) in a photograph album.
• Have learner describe the actions that were just completed using sequence strips for the activity.
• Have learner describe how a food item (e.g., cookies) was made using a recipe from a cookbook.
• Have learner provide location clues to give peers an idea of where to go next during a treasure hunt at a birthday party.

5. Basic Communication Skills: Asks Questions

GOAL: INCREASE ASKING QUESTIONS
SAMPLE OBJECTIVE: When presented with a photo or picture of someone he or she does not know, learner will ask, “Who is
that?” in 80% of the targeted opportunities.

SAMPLE MEANS OF COMMUNICATION

• Communicative gestures: Physical proximity or looking at person
• Emergent: Vocalization or speech, signs, photographs, pictographs, voice output system, or written language to convey a simple message
(e.g., What? Who? Where? When? Why?)
• Verbal: Speech, sign language, photographs, pictographs, voice output system, or written language to convey a multiword message (e.g.,
What is ________? Who is ________? Where is ________? When is ________? Why does ________?)

SAMPLE ACTIVITIES: One-to-one with adult

Contexts: Social play and leisure activities where learner is motivated to request information
Materials: Motivating objects (e.g., walkie-talkies, books, toys), another adult, visual supports, and augmentative and alternative
communication (AAC) as needed
Procedures:
Activity Idea 1: Use walkie-talkies and model asking, “Who is it?” Put learner in a location where he or she is unable to see adult. Use walkie-
talkies and wait for learner to ask the question.
Activity Idea 2: Read a book with learner and frequently ask, “What is (character) doing?” Point to the picture and stop. Wait and watch for
learner to ask the what question.
Activity Idea 3: Place motivating objects in a bag. Take out an object or toy and ask a yes-or-no question such as, “Is this Thomas the train?”
Then, have learner take an object out of the bag. Wait for him or her to request information and ask a yes-or-no question.
Activity Idea 4: Hide preferred objects in different locations. For instance, put the object in your pocket. Say, “Where’s the (object)?”
Continue playing the game, hiding the object farther away. Wait for learner to ask, “Where is it?”

SAMPLE ACTIVITIES: Group with one or more peers

Contexts: Play and leisure activities where learner is motivated to request information
Materials: Music; a large jar, pretend cookies or other fun objects, accompanying visual supports as appropriate
Procedures:
Activity Idea 1: Write the names of all group members on sticky tags. Attach the tags on the forearm of each person. Play music and have
group members move around. Have them stop when the music stops, tap a peer’s forearm gently, and say the name on the tag. This can
teach the skill of saying another person’s name to get his or her attention and request information.
Activity Idea 2: Give each group member a pretend cookie. Position one peer in the middle of a circle, blindfolded and sitting with his cookie
behind him. Have another peer sneak up, take the blindfolded peer’s cookie, and hide it in the cookie jar. Lead the group in singing
“Who Put the Cookie in the Cookie Jar?” Have peer in the center guess who took his or her cookie. Have a peer prompt learner as
appropriate to ask peers “Who put the cookie in the cookie jar?” Repeat the sequence many times in the same manner.
Activity Idea 3: Have one peer face away from the group with his or her eyes closed. Sing “If You’re Happy and You Know It.” Have another
peer demonstrate an action. Have the child with the closed eyes ask, “What’s he doing?” The group then gives him or her clues. Have the
child guess the action, and when he or she turns around have everyone doing the action.

WAYS TO GENERALIZE SKILLS

• Have learner say person’s name when talking on the phone and ask a question.
• Have learner ask, “Who is absent?” during attendance.
• Have learner ask, “What is it?” before lifting flap when reading books with flaps.
• Have learner ask What? questions during a roving reporter class project.
• Have learner ask, “Can I have more water?” when server comes to the table.

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• Have learner ask, “Do you have any (name of card)?” while playing card game such as Go Fish.
• Have learner ask Where? questions when playing Where Is Thumbkin?
• Have learner ask When? question when someone says he or she has a birthday coming up.
• Have learner ask Why? question when someone says he or she needs a vacation.

6. Socioemotional Skills: Expresses Basic Feelings

GOAL: INCREASE EXPRESSION OF BASIC FEELINGS
SAMPLE OBJECTIVE: When learner is feeling discomfort, he or she will communicate the need to “relax” verbally or through use
of a communication card in 80% of targeted opportunities.

SAMPLE MEANS OF COMMUNICATION

• Communicative gestures: Physical proximity, looking at person, moving persons/objects
• Emerging: Vocalizations, speech, signs, photographs, pictographs, voice output system, or written language to convey a simple message
(e.g., break, relax, mad, happy)
• Verbal: Speech, signs, photographs, pictographs, voice output system, or written language to convey a multiword message (e.g., I need a
break, I need a deep breath, I am mad, I am sad)

ACTIVITY SUPPORTS AND STRATEGIES: One-to-one with adult

Contexts: Stressful social environments in which learner demonstrates a high level of discomfort or frustration
Materials: A relaxation procedure (e.g., visualization, deep breathing, counting, stretching), visual supports (cue card that signifies relaxation
procedure), augmentative and alternative communication (AAC) as needed
Procedures:
• Include a relaxation time in the daily schedule of activities. Teach relaxation procedure when individual is calm, then generalize to times
when he or she is upset. Use a cue card to prompt use of a particular procedure to relax.
• Make a social narrative or book for learner with autism depicting stressful activities. While looking at the book, pair stressful activities with
the cue card for relaxation. Use simple language accompanied by pictures, such as “When work makes me upset, I can shake my hands and
take a deep breath.” Read frequently throughout the day. Be sure to use the same language from the book during times when learner is
actually upset.
• Use visual imagery to teach relaxation and self-control strategies to cope with a stressful situation. Depict a stressful situation as a picture
sequence paired with a simple verbal script. Ensure that relaxation procedures conclude with desired behaviors and positive outcomes.
• Review relaxation procedure multiple times daily. Have individual rehearse before, during, and after actual stressful situations. Goal is for
learner to demonstrate desired behaviors in natural settings using visual and verbal images as cues.

SAMPLE ACTIVITIES: Group with one or more peers

Contexts: Physical games and activities where there is motivation to communicate basic emotions
Materials: Yoga video, mirror, visual supports (e.g., cue cards), and AAC as needed
Procedures:
Activity Idea 1: Encourage learner with autism and peer to experiment with making different faces in the mirror. For example, model making
a mad face and saying, “I’m mad!” Have them take turns making faces in the mirror, allowing them to decide which faces to make. Wait
for learner to express basic feelings in the mirror. Leave a mirror out so learner can experiment with making various faces throughout the
day.
Activity Idea 2: Color-code activities on students’ daily schedule by the feeling each might evoke. For example, color-code preferred activities,
such as snack time and recess, in yellow and label them, “Makes me feel happy!”
Activity Idea 3: Watch a yoga video with the group. Practice two or more of the yoga postures. Pair a cue card, “relax,” with the yoga
positions. Review the relaxation procedure with the group multiple times daily. Rehearse yoga positions before, during, and after actual
stressful situations once the procedure is familiar. The goal is for learner to demonstrate desired behaviors in natural settings using visual
and verbal images as cues.

WAYS TO GENERALIZE SKILLS

• Have learner request a break when feeling discomfort (e.g., smells bad) at the zoo.
• Have learner request a calming activity when frustrated because a peer wins a game or takes an item away.
• Have learner indicate a need for a relaxation procedure when feeling overwhelmed by the sensory environment.
• Have learner request a hug when feeling sad about grandmother being sick.
• Have learner express anger when a peer pushes him or her.
• Have learner say, “She looks happy” when neighbor is smiling.
• Have learner express, “He is sad” when person on television is crying.

7. Socioemotional Skills: Express Complex Feelings

GOAL: INCREASE EXPRESSION OF COMPLEX FEELINGS
SAMPLE OBJECTIVE: In a situation that triggers an emotion, learner will spontaneously communicate emotion (e.g., “I am
scared,” I don’t like this”) verbally or through use of a communication card in 80% of targeted opportunities.

SAMPLE MEANS OF COMMUNICATION

• Communicative gestures: Physical proximity and looking at person
• Emerging: Vocalizations, speech, signs, photographs, pictographs, voice output system, or written language to convey a simple message
(e.g., like, yuck, calm, sleepy, proud, scared)

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 • Verbal: Speech, signs, photographs, pictographs, voice output system, or written language to convey a multiword message (e.g., I like gym,
I feel calm, My stomach hurts, I did it myself, That noise makes me nervous, I don’t know the answer)

SAMPLE ACTIVITIES: One-to-one with adult

Contexts: Activities where emotions are experienced and learner is motivated to communicate
Materials: Audio of thunder or frightening noise, scary book, flashlight, blanket, visual supports, and augmentative and alternative
communication (AAC) as needed
Procedures:
Activity Idea 1: Play scary noise softly (e.g., Halloween music, thunder). Demonstrate how learner can lower the sound or make it louder and
that he or she has control of the audio. Each time learner raises the volume, say, “I’m scared because that creepy music makes me
nervous.”
Activity Idea 2: Turn off the lights and pull down the shades to make the room dark, and read a scary book (e.g., ghost story). Use the
flashlight and blanket to make the interaction fun. Say “I am afraid.” Continue to read the story and talk about things that make people
afraid or nervous. Wait and watch for learner to express fear or nervousness.
Activity Idea 3: Make a social narrative or story for the emotion you are targeting. Use photographs of learner experiencing or acting out
various emotions. Put one photograph on a page and write text—for example, “I feel scared/proud/happy when I (complete activity).”
Continue on each page with a new photograph and a new caption. Read the book as frequently as possible.
Activity Idea 4: Wait to see if learner expresses feelings when an experience occurs. Prompt learner if he or she does not. Help learner make
concrete associations (e.g., swinging is done, so you are mad).

SAMPLE ACTIVITIES: Group with one or more peers

Contexts: Activities where emotions are experienced and learner is motivated to communicate
Materials: Books about emotions, visual supports, and AAC as needed
Procedures:
Activity Idea 1: Read a book about emotions to the group. Ask each group member to label how he or she feels and place the corresponding
picture on a numeric scale (e.g., 5-point scale) or color chart (e.g., red, yellow, green, blue). Pair spoken language with signed, gestural, or
pictographic cues as needed. Model for learner: “I put my picture on blue because I am feeling sad.” Have a peer prompt learner if he or
she does not express a feeling.
Activity Idea 2: Make a video in the class capturing different emotions. Watch the video with the volume turned off, and label the emotions
verbally or with visuals. Model answers at the beginning, but then stop labeling the emotions and wait for learner to label them. Have
peer prompt learner if he or she does not respond.
Activity Idea 3: Use a variety of pictures depicting things with which group members are familiar. Label two boxes with I like and I don’t like.
Show pictures one at a time. Allow learner and peers to label each picture and put the pictures in the appropriate box.

WAYS TO GENERALIZE SKILLS

• Have learner send a card signed with love on relative’s birthday (e.g., shows affection).
• Have learner state that he or she feels calm about the change when a teacher is absent from school.
• Have learner state that he or she is hurt after tripping and falling.
• Have learner point out feelings when a child is holding a teddy bear (e.g., “He’s holding teddy because he likes it. Me too!”).
• Have learner show his or her medal and demonstrate pride after finishing a track meet (e.g., “I ran fast.”).
• Have learner acknowledge feeling scared during a thunderstorm (e.g., “That noise is loud.”).
• Have learner declare, “I don’t know what to do” when given a confusing worksheet.

8. Socioemotional Skills: Prosocial Statements

GOAL: INCREASE PROSOCIAL STATEMENTS
SAMPLE OBJECTIVE: During a structured play activity, learner will spontaneously ask a peer to play in 80% of the opportunities.

SAMPLE MEANS OF COMMUNICATION

• Communicative gestures: Physical proximity, looking at person, moving person/object (e.g., toward, away, pull, push), reaching,
shaking/nodding head, or hugging
• Emerging: Vocalizations or speech, signs, photographs, pictographs, voice output system, or written language to convey a simple message
(e.g., more, hi, high five, play, here, please, no, sorry)
• Verbal: Speech, signs, photographs, pictographs, voice output system, or written language to convey a multiword message, (e.g., I want
more, I need a hug, Will you play with me?, May I have a cookie?, Do you want a cookie?, That’s mine.)

SAMPLE ACTIVITIES: One-to-one with adult

Contexts: Social play and leisure activities that include motivation to use prosocial communication
Materials: Visual supports and augmentative and alternative communication (AAC) as needed
Procedures:
Activity Idea 1: Sit opposite learner and hold hands. Rock back and forth, singing “Row, Row, Row Your Boat.” Experiment with rate of
movement and song to determine what learner enjoys. Stop rocking and wait for a request that you play more of the game. Maximize use
of verbal modeling and limit use of verbal prompts in the form of questions.
Activity Idea 2: Write a social narrative or story that describes situations in which learner can ask others to play. Include audio and
illustrations in story as needed. Use concrete and simple language that mirrors language comprehension level of learner. Read the story as
part of a daily routine. Send a copy of the story home and encourage the parents to read the story as well.
Activity Idea 3: Use video modeling and record learner asking peer to play. Show learner the video before play and leisure activities.

SAMPLE ACTIVITIES: Group with one or more peers

Contexts: Social play and leisure activities that include motivation to use prosocial communication

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 Materials: Visual supports and AAC as needed
Procedures:
Activity Idea 1: Give peer something that is highly motivating to learner. Have learner gain peer’s attention to retrieve the desired item.
Activity Idea 2: Send learner to an activity area that you know is a peer’s favorite. When learner makes a choice to play, say “(Peer’s name) is
there; you can ask him or her to play.” Wait to see whether learner asks peer to play. Prompt if learner does not respond. Continue to set
up situations in which learner must ask peer to play. Repeat many times in the same manner. Decrease the number of prompts as
appropriate.
Activity Idea 3: Play a game such as Duck, Duck, Goose. Teach learner to say, “Will you play?” Pair spoken language with signed, gestural,
or pictographic cues as needed. Wait and watch for learner to ask peers to play. Prompt learner as appropriate if he or she does not
respond. Repeat many times in the same manner. Decrease the number of prompts as appropriate.

WAYS TO GENERALIZE SKILLS

• Have learner initiate a social greeting to a cashier at the store.
• Have learner say, “Thank you for playing” after playing a game with a peer.
• Have learner ask to play with a peer on the playground at recess.
• Have learner say, “Don’t do that” and “I didn’t like that” when peers are throwing sand in the sandbox.
• Have learner say, “Thank you” when receiving an invitation for a birthday party.
• Have learner say, “Excuse me” when accidentally bumping into another person.

9. Basic Conversational Skills: Verbal Reciprocity

GOAL: INCREASE VERBAL RECIPROCITY
SAMPLE OBJECTIVE: Using visual supports (e.g., AAC, cue cards), learner will spontaneously use four conversational exchanges
in highly predictable situations (e.g., telephone greeting, delivering message, arrival home from school) in 80% of targeted opportunities.

SAMPLE MEANS OF COMMUNICATION

• Communicative gestures: Physical proximity, looking at person, reaching, shaking/nodding head, or hugging
• Emerging: Vocalization, speech, signs, photographs, pictographs, voice output system, or written language to convey simple messages
(e.g., hey, bye)
• Verbal: Speech, signs, photographs, pictographs, voice output system, or written language to convey a multiword message (e.g., I gotta go
now, I see a [name of object], yesterday, I went swimming)

SAMPLE ACTIVITIES: One-to-one with adult

Contexts: Activities that provide motivation to engage in reciprocal back-and-forth verbal communication
Materials: Visual supports (e.g., cue cards) and AAC as needed
Procedures:
Activity Idea 1: Make cue cards of messages to initiate conversations, such as Hi, How are you?, or Who is this? Individualize with
photographs, pictographs, or written text. Use cue cards to remind learner of what to say and/or to provide learner with an alternative
means of communication. Preview and practice with the cue cards in naturally occurring adult–learner interactions around school and in
community.
Activity Idea 2: Make a cue card with a telephone script, such as Hello. Who are you calling to speak with? Accompany the text with pictures.
Attach the cue card with Velcro next to every telephone. When the telephone rings, prompt learner to get the cue card, pick up the
telephone, and follow the script. Create a telephone conversation script with a person learner is motivated to speak to, give a copy of the
script to that person, and keep one by the telephone. A basic script might read:
Friend or relative: Hi, (name).
Learner: Hi, (name). How are you?
Friend or relative: Great. How are you?
Learner: Good.
Friend or relative: Tell me one thing you did at school today.
Learner: I ate my lunch.
Prompt learner as needed if he or she does not respond or complete the telephone script. Repeat the sequence many times in the same
manner. Have the designated relative or friend call the individual with autism frequently.

SAMPLE ACTIVITIES: Small group with one or more peers

Contexts: Activities that provide motivation to engage in reciprocal back-and-forth verbal communication
Materials: Journals, visual supports (e.g., social narrative), and AAC as needed
Procedures:
Activity Idea 1: Create a social narrative that includes the whole class. Provide an example on each page, such as, “Katie says ‘Hi, how are you’
when she is talking to her friend”; “John says ‘Hi’ when he is talking to the librarian”; “Alex says ‘Excuse me’ when he delivers the
attendance to the school office.” Read the social narrative aloud to the group daily. Use pictures of the group members on sticks to act out
the story. Use the language in the social narrative during similar real-life situations.
Activity Idea 2: Create journals with a limited choice of responses for learner and peers who have difficulty with open-ended tasks. Pick a set
time each day to complete journals with the help of an adult, if needed. Structure the journals with prompts such as “Today, I ________;
Yesterday, I ________; Tomorrow, I want to ________.” Individualize journals using pictographs, photographs, or written text. Pair two
partners with similar abilities to share entries once journals are completed. Prompt them to take turns sharing information in their
journals. Once they are familiar with the format of their journals, have group members share the information without reading it so it is
more of a conversational exchange. For example:
Peer: Today, I took the bus to school.
Learner: Today, my mom brought me.
Peer: Yesterday, I went swimming.
Learner: Yesterday, I went to the park.

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 Peer: Tomorrow, I want to play on my computer.
Learner: Tomorrow, I want to go to McDonalds.

WAYS TO GENERALIZE SKILLS

• Have learner gain peer’s attention to say “hi” or “bye” during natural transitions.
• Have learner say “hi” and “bye” to the office staff when delivering a message to the school office.
• Have learner share information in a conversation about topics outside of special interests using a script.
• Have learner provide feedback that he or she is listening during conversation in a car (e.g., “Uh-huh,” “Okay”).

10. Basic Conversational Skills: Verbal Topics

GOAL: INCREASE VERBAL TOPICS
SAMPLE OBJECTIVE: Using communication supports, learner will spontaneously engage in a reciprocal conversation of four or
more exchanges on two topics outside his or her interest area in 80% of the targeted opportunities.

SAMPLE MEANS OF COMMUNICATION

• Communicative gestures: Physical proximity, looking at person, shaking/nodding head
• Emerging: Vocalization, speech, signs, photographs, pictographs, voice output system, or written language to convey a simple message
• Verbal: Speech, signs, photographs, pictographs, voice output system, or written language to convey a multiword message

SAMPLE ACTIVITIES: One-to-one with adult

Contexts: Natural and structured interaction opportunities that include motivation to have a conversation
Materials: Photograph album, visual supports (e.g., cue cards to prompt ASK A QUESTION), and augmentative and alternative
communication (AAC)
Procedures:
Activity Idea 1: Look at learner’s photograph album, which includes recent events. Have him or her tell you one thing about each photo.
Respond by making one comment or asking one question about each photo. Continue the turn-taking exchange. Next, show your own
photo album. Point to each photo and describe each one. Wait for learner to ask you a question or make a comment about your photo.
Prompt learner with cue cards if he or she does not respond. Continue to take turns, repeating many times in the same manner. Decrease
the number of prompts as appropriate. Gradually elaborate on the conversation so that there are a number of exchanges for each
photograph.
Activity Idea 2: Elicit novel conversation by using words from a word wall in the classroom. Maximize the use of verbal modeling and give
learner time to respond. Prompt learner to take a turn if he or she does not respond. Repeat many times in the same manner. Decrease
the number of prompts as appropriate. Provide structure to the conversation, modeling simple constructions such as:
People-Do-What
Model: “Kathy plays blocks.”
Learner: “Dad reads newspaper.”
People-Where-Do-Say
Model: “Ty on playground swinging says this is fun.”
Learner: “Dad at office typing on computer says this is hard.”

SAMPLE ACTIVITY: Small group with one or more peers

Contexts: Natural and structured interaction opportunities that include motivation to have a conversation
Materials: Materials to make a conversation book (e.g., paper, pencils)
Procedures:
1. Make a book that organizes topics for conversations. Individualize the conversation book with photographs, pictographs, or written
text. Make detailed lists of favorite topics (e.g., television, sports, foods). A page in the book might look like this:
• Topic: Sports teams
• Learner: I like ________ because ________.
• Peer 1 name: She likes ______ because ________.
• Peer 2 name: He likes ______ because ________.
2. Use the book to review the interests of peers prior to social situations. The book helps learner summarize conversational topics that are
appropriate during interactions with peers. For example:
• I can ask Peer 1 about ________.
• Peer 1 and I can talk about ________.
• I can ask Peer 2 about ________.
• Peer 2 and I can talk about ________.

WAYS TO GENERALIZE SKILLS

• Have learner choose age-appropriate conversation topics when talking to a younger child.
• Have learner change topics after talking about a topic for a period of time.
• Have learner take turns in conversation in order to not monopolize the conversation while talking on the school bus.
• Have learner participate in conversation on topics outside of own interest areas when engaging with a peer.
• Have learner ask for clarification when complex academic vocabulary is used in class.
• Have learner maintain conversation using appropriate topics when talking on the phone with a stranger.

11. Basic Conversational Skills: Nonverbal Conversation

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 GOAL: INCREASE NONVERBAL CONVERSATION
SAMPLE OBJECTIVE: When engaging in a conversation, learner will sit or stand 1–2 feet from communication partner in 80%
of observed conversations.

SAMPLE MEANS OF COMMUNICATION

• Communicative gestures: Physical proximity, facing toward speaker, looking at person, moving person’s hand/face, reading emotions,
nodding, or touching
• Emerging: Voice volume
• Verbal: Voice volume

SAMPLE ACTIVITIES: One-to-one with adult

Contexts: Natural and structured interaction opportunities that include motivation to have a conversation
Materials: Video recorder and visual supports (e.g., cue cards)
Procedures:
Activity Idea 1: Watch a video highlighting familiar adults and peers exaggerating nonverbal cues (e.g., body language) both appropriately
and inappropriately (e.g., standing 1-2 feet away or standing too close). Assist learner in identifying the nonverbal skills presented.
Preview the video prior to social interactions and use a cue card as an instructional prompt.
Activity Idea 2: Create and review a social encyclopedia to help learner visualize a relationship between social behaviors.
Activity Idea 3: Role-play what types of touching are acceptable during a conversation. Exaggerate the interaction with animation and make
it fun. Encourage learner to role-play these situations as well. Prompt learner to describe appropriate types of touching (e.g., “Tapping a
shoulder gently is okay”). Repeat many times in the same manner. Decrease amount of prompts as appropriate.
Activity Idea 4: Make a cue card or a scale that reads, 1 = quiet whisper, 2 = just right inside voice, 3 = loud yell. Audio record voice volumes and
listen to them together. Once learner can identify whether his or her voice sounds just right on audio, use cue card to prompt appropriate
voice modulation in natural contexts.

SAMPLE ACTIVITIES: Small group with one or more peers

Contexts: Natural and structured interaction opportunities that include motivation to have a conversation
Materials: Hula hoops and sociobehavioral display clarifying desirable social behaviors
Procedures:
Activity Idea 1: Have learner and peers stand in their own hula hoops to provide a visual for the distance that they should stand from a
communication partner.
Activity Idea 2: Play a game in which group members stand back-to-back with a partner. In an animated tone, say, “Ready? Go!” which
signals each partner to turn around, look at his or her peer, and imitate each other’s funny nonverbal behavior (facial expressions, gestures,
body postures).
Activity Idea 3: Individualize a sociobehavioral display with photographs, pictographs, or written text. Use it to refocus attention during
social situations. Clearly say the desired behaviors stated in positive, concrete, and concise terms on the display, such as:
• I will look at the person with whom I am talking.
• I can touch someone’s arm gently.
• I will use my inside voice.
• First, I will start a conversation.
• Then, I will watch the other person.
• That person will look at me and smile or nod if he wants to talk to me.
• If the other person wants to talk, I can keep talking.

WAYS TO GENERALIZE SKILLS

• Have learner take one step back from conversational partner when provided a gestural cue that signals “not too close.”
• Have learner identify which individuals are spaced correctly for a conversation using photos of people who are standing and talking.
• Have learner attend and orient to speaker when a community member asks a question.
• Have learner discriminate appropriate and inappropriate touching during a conversation while watching a video.
• Have learner modulate volume of voice appropriately for the setting when at the library.
• Have learner wait for confirmation (e.g., nod, smile) before continuing message after conversation is initiated.

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 CHAPTER 9

Collecting Data to Measure Authentic Progress

LEARNING GOALS:
1. Learn to collect annual and ongoing data to measure authentic progress (i.e., functional generalization of
social and communication skills).
• Monitor an individual’s annual progress in social and communication skill development to measure
improvement over time.
• Monitor an individual’s ongoing progress in social and communication skill development to measure
the effectiveness of intervention plans and specific progress toward goals and objectives.

T he current climate in education emphasizes data-based decision making and comprehensive progress
monitoring of students. IDEA (IDEA, 2004) requires an IEP to include measurable annual goals
designed to meet the child’s needs that result from the disability, so as to enable the student to be
involved in and make progress in the general education curriculum (§300.320). IDEA also requires schools to
measure and provide periodic reports on the progress the student is making toward meeting the annual goals
to the family. Thus, during the course of a child’s education, data pertaining to academic skills, developmental
functioning, and behavior must be collected, evaluated, and reported. These data can drive intervention
decisions regarding skills to increase (e.g., social and communication skills) and behaviors to decrease (e.g.,
restricted or repetitive behaviors interfering with learning).
The cornerstone of successful intervention is determining whether an individual is making progress and
whether the intervention is effective. To do this, an interventionist must be skilled in data collection and
progress monitoring methods. Progress monitoring involves the annual and ongoing review of the child’s skills
and response to provided interventions. Progress monitoring occurs for two equally important reasons:
• To assess and measure general performance and progress on an annual basis
• To track progress toward specific goals and objectives on an ongoing basis by quantifying a rate of
improvement or responsiveness
Annual progress monitoring is conducted through the use of formal and informal assessment data (e.g.,
ASCS-2) to track developmental changes over time and contribute to the creation of the IEP. In contrast,
ongoing (i.e., daily or weekly) progress monitoring is conducted through the use of data collection to monitor
a student’s progress toward specific goals and objectives. Both means of progress monitoring serve an
important purpose: to determine the effectiveness of the instruction and intervention provided to the child.
This chapter explores a variety of ways to monitor a child’s progress with skill development on a regular
basis. It includes a review of different data collection methods and sample data collection forms that can be
used to track both acquisition and generalized use of learned skills. Because of the inherent complexity of
monitoring social and communication development, both quantitative and qualitative measures are discussed.

OVERVIEW OF PROGRESS MONITORING

Assessments such as the ASCS-2 can be used to monitor social and communication growth on an annual
basis. As discussed previously, both a quantitative and a qualitative summary of the information gathered from

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assessment (e.g., ASCS-2) can be generated to show developmental progress and changes from year to year.
Positive changes, such as a higher level of engagement in social play and leisure, increased social participation
in different group situations, and more self-control in community settings, reflect progress. Increases in the
individual’s range of communicative functions and reciprocal discourse skills also can be quantified to show
progress. Finally, data about the child’s level of motivation, flexibility, engagement, and socioemotional
comfort can be captured through assessments (e.g., ASCS-2) to reflect social, emotional, and behavioral
changes.
To monitor a student’s ongoing progress toward achieving specific skills, additional data collection tools
beyond one formal or informal assessment measure are needed. Many educators are skilled at collecting
academic data, but social and communication skills are more challenging to measure. This is because it is
important to measure not only acquisition of the skill but also progress in demonstrating the skill across
settings. The ultimate goal of social and communication instruction is to help the child master social and
communication skills in instructional settings and then generalize those skills in natural, noninstructional
settings. Precise data collection is thus required at each of the three levels of skill development (i.e.,
emergence/acquisition, mastery, and generalization) in order to provide appropriate instruction and ensure
functional skill use.

Monitoring Social and Communication Skill Development

The ability to monitor social and communication skill development begins with basic knowledge of how to
observe and record a student’s progress toward a defined objective, and this includes five basic steps:
1. Specify the objectives: Begin by reviewing assessment information (e.g., ASCS-2 results) and the
prioritized skills for which goals have been written. In order to reliably monitor progress, each goal must
include specific objectives focused on the prioritized skills the child needs to achieve. Objectives are
stated in clear, observable terms; that is, what one wants to see the child with autism doing. For
example, the goal may be to increase communication skills. The three specific objectives might be to
follow group verbal instructions, give a verbal compliment, and verbally request a break.
2. Define the skill criteria: Next, describe the conditions under which the child will demonstrate the skills
specified in the objectives. Then, determine the criteria for demonstrating the skill, and write those
criteria into the objective. These criteria are determined based on the level of skill acquisition being
targeted:
• Emerging: Emergence/acquisition is performance within a controlled instructional setting with at
least one partner. The child demonstrates the skill in one instructional setting and/or with at least one
adult or peer. The criterion for demonstrating an emerging skill might be to give a verbal compliment
during one classroom group activity (e.g., show and tell).
• Mastery: Mastery is performance across multiple instructional settings with multiple partners. The
child demonstrates the skill across three or more instructional settings with multiple adult or peer
partners. The criterion for mastering a skill might be to follow whole-group verbal instructions during
familiar school-based activities.
• Generalization: Generalization is performance across novel, noninstructional settings with multiple
partners. The child demonstrates the skill across three or more novel, noninstructional settings with
both adults and peers. The criterion for skill generalization might be to request a break from doing
difficult work without adult reminders (i.e., prompts) at both home and school.
3. Pose the data question: Next, determine how to measure the child’s progress toward the specific
objective and what type(s) of data needs to be collected. The team might need to collect data to address
any of the following questions:
• How frequently does the skill occur?
• For how long or when does the skill occur?
• What support is needed for the skill to occur?
• How does the skill compare to same-age peers?
• Where is the target skill observed?
After the team determines the questions to be answered, criteria for data collection are written into the
objective. The following are examples of criteria for data collection that have been embedded into objectives:

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 • Give a verbal compliment during a classroom group activity (e.g., show and tell) in 80% of
opportunities as measured by ______________.
• Follow whole-group verbal instructions during familiar school-based activities independently for four
of five times as measured by ______________.
• Request a break from doing difficult work at both home and school without adult reminders (i.e.,
prompts) 80% of the time as measured by ______________.
4. Determine what data collection format to use to answer the data question: As indicated in Table 9.1,
data collection measures are both quantitative and qualitative, and the type of data collected depends on
the data question to be answered.

Table 9.1. Data questions and formats

Data question Data collection format
How frequently does the skill occur? Quantitative: Frequency and/or percentage
How long or when does the skill occur? Quantitative: Duration, latency, time sampling, and/or percentage
What support is needed? Quantitative: Task analysis
Is the skill similar to skills demonstrated by same-age peers? Quantitative: Generalization probe
Qualitative measure: Rating scale
Where does the skill occur? Qualitative: Rating scale and/or anecdotal record

• Quantitative measures are numerical in nature, answering questions such as “How frequently?”,
“When?”, “How long?”, or “How much support is needed?”.
• Qualitative measures are more subjective in nature, answering questions such as “Where?” or “How
does it compare?”.

The data question to be answered determines the type and format of data collection that is used to
monitor progress over time. Using the previous examples of specific objectives, if the skill criteria are stated as
a percentage of time or include frequency of occurrence (i.e., 80% or 4 of 5), then the data would be
quantitative; that is, noting the number of times the student did or did not demonstrate the skill. If the skill
criteria are generalized across home, school, and community settings, then the data might be a qualitative log
of the different natural settings in which the skill was observed.
5. Determine whether the collected data measures authentic progress: The final and most crucial step is to
ensure that the data being collected measure authentic progress. Authentic progress is captured by those
measures that assess a student’s ability to demonstrate generalized, functional use of skills that have been
taught initially in controlled instructional settings. That is, how will the data show that the skills being
taught are used in a functional way? Remember that the ultimate goal of intervention is the functional
use of the target social and communication skills. This goal is not fully achieved until there are data to
show generalization and functional skill use.
The following sections describe how to use both quantitative and qualitative data to measure social and
communication skill development. See Table 9.2 for a comparison of these two types of data collection.

Table 9.2. Quantitative and qualitative progress monitoring measures

Quantitative measures Qualitative measures
Direct measurement forms can include: A portfolio might include:
Frequency data Logs (e.g., narrative from observations)
Number of spontaneous instances of skill Anecdotal information (e.g., observation notes)
Number of settings in which skill occurs Lists (e.g., list of play and leisure activities; settings where skill is observed)
Number of different skill responses (e.g., different means to convey one communicative function) Natural samples (e.g., communication)
Time sample data Audio recordings (e.g., conversations)
Length of attention (e.g., during solitary play and leisure activities, group activities) Video recordings (e.g., social play and leisure interactions)
Checklists Rating scales (e.g., to measure skill use or intensity of restricted and repetitive behaviors)
Level of prompting required for skill Ecological inventories (e.g., community skills)
Task analysis of skills (e.g., community) and subskills (e.g., conversation)

Quantitative Data Collection Different social and communication skills lend themselves to different forms of
direct measurement. For social and communication skills, data collectors need to move beyond just capturing
frequency data based on the number of times a child engages in a targeted behavior. For instance, progress on
skills may be measured in a number of other ways that reveal valuable information about the level of skill
acquisition, spontaneous skill use, or the nature of the skills an individual possesses. In terms of frequency, the
team might measure the number of spontaneous instances of skill use, number of settings in which the skill
occurs, or the number of different skill responses (e.g., count the number of different communicative means
used to convey one communicative function). Or, it may be important to conduct a task analysis to gather
information on the level of prompting required for each step of a skill sequence if the goal is independent
performance of the skill. When collecting data, think about how to record data in both contrived and natural

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settings. Direct data collection measures can take many forms, including the following:
1. Frequency data: These are data collection methods focused on the number of times a skill occurs relative to
opportunities. Frequency, also known as event recording, should be recorded beyond one setting. For
example, collect data in various one-to-one, structured, and unstructured settings, both contrived and
natural.
2. Duration, latency, or time sampling data: These are data collection methods focused on the concept of time.
• Duration data capture the length of time a behavior occurs.
• Latency data capture the length of time it takes after an instruction or opportunity is provided for the
child to start and engage in expected behavior.
• Time sampling data measure how often the behavior occurs or does not occur relative to the
opportunities and total length of time observed. Data can be collected on whether the child engaged in
the behavior for an entire time period (i.e., response duration) or whether the behavior was being
engaged in at a specific time (e.g., at the end of a time period such as 5 minutes).

The following vignette highlights examples of quantitative data collection in a classroom setting and
demonstrates how the type of data collection varies from student to student depending on each student’s
objectives and needs.

A classroom teacher records data on three different students in her class on an ongoing basis throughout the day. For
example, during the music lesson, she records the following: 1) how many times one student followed the group verbal
instructions, using a frequency data sheet; 2) how long one student attended to the group activity by observing his
behavior once every 5 minutes and recording +/− on a time sample data sheet; and 3) when one student needed
prompting assistance, making notes on a sheet that included a list of the basic tasks all the students need to do during
the lesson (i.e., a task analysis). She was able to observe the three students, record the data, and maintain a natural
flow to the lesson by using simple paper and electronic data forms.

Qualitative Data Collection Qualitative data capture the authentic, functional use of skills that have been
taught and thus present the truest picture of a child’s social and communication development. Keeping an
individual portfolio is recommended to monitor social and communication progress. Individual portfolios are
an accumulation of meaningful products that are collected over an extended period of time to verify individual
progress toward specific objectives. The items for the individual portfolio might be collected on a quarterly
basis to accompany progress reports. An individual portfolio might include (but is not limited to) the
following:
• Narratives: Include observation logs, anecdotal notes, or lists. Examples include notes on where the child
was observed using a previously taught skill or a log that lists the type of play and leisure activities the child
participated in each day.
• Natural samples: Include communication samples that list both what the child says and the communicative
function. An example would be notes describing communication used to request, comment, question, or
express feelings across settings.
• Audio and video recording: Include one-to-one sessions and/or peer group interactions captured on audio or
video to identify child’s skill use. Recordings may include communication samples or engagement in play
and leisure activities.
• Rating scales: Include scales to measure skill use or skill level in different settings. For example, the team
might rate the child’s level of group participation, motivation, exploration, flexibility, engagement, and
self-regulation in home, school, or community settings.
• Ecological inventories: Include assessments to determine the level of the child’s independence in skill use at
home, at school, and in the community. An example would be an assessment of the child’s ability to
complete an activity, such as ordering food at a fast-food restaurant.

MONITORING SKILL EMERGENCE, MASTERY, AND

GENERALIZATION
Given the specific challenges with generalization of social and communication skills, it is important to use

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both quantitative and qualitative data collection systems to measure emerging skill acquisition and skill
mastery separate from skill generalization. The following are some considerations for data collection at each
level of skill acquisition:
1. Emerging skill: The most common form of data collection used currently is to record an individual’s
responses to direct instruction during one activity. This is usually a contrived instructional context (e.g.,
in an artificially designed or natural setting) that allows repeated practice or elicitation of a specific skill.
The most precise data are collected for this initial instructional condition.
2. Skill mastery: Of equal importance are data that reflect the child’s progress on specific skills that are
directly taught across a variety of activities. These data determine skill mastery. Data are needed to show
that the student has learned a specific skill across multiple instructional conditions (e.g., varying
activities, materials, and people such as adults versus peers). It can be difficult to collect data on skill
mastery when instruction occurs in the natural setting, but this is an essential part of progress
monitoring.
3. Skill generalization: It is important to ensure that data are collected on generalized functional skill use,
because these are the most critical pieces of data. Many times, interventionists measure skill
generalization to check whether a previously mastered skill continues to be maintained or remembered,
but these planned checks occur in the same situation in which the skill was taught and practiced.
Generalization data are different. Generalization data are a record of the child’s spontaneous use of a
social or communication skill in novel contexts in which direct instruction has not occurred. The
generalization data show whether the child uses a new skill in a novel situation without adult support.
Generalization indicates that the learned skill is now maintained by natural contingencies.
Generalization data, like emerging and mastery data, can be quantitative or qualitative. Quantitative
measures record the number of times functional skill use is observed across a wide range of novel stimuli,
unfamiliar people, and new contexts. Qualitative measures summarize skill use by collecting samples of
the child’s skills or by having caregivers and professionals rate the child’s abilities in natural settings.

DATA COLLECTION FORMS

This next section describes a number of sample data collection forms that can be used to document emerging,
mastered, and/or generalized skills. Both quantitative and qualitative data collection templates are provided.
Case studies, along with partially completed data forms, are included to illustrate use of the forms. Blank data
forms can be found in the Chapter 9 Appendix.
These data forms can be duplicated and used in a paper format. In addition to paper data, technology can
be accessed for progress monitoring. A proliferation of applications (apps) is available on handheld computers
and tablet devices that can increase the ease and effectiveness of data collection. Some technology allows the
user to design his or her own data collection system. Some programs allow interventionists to streamline the
data collection process using mobile technology. Given the rapid pace with which new technology and
applications are made available to consumers, options for monitoring individual performance will continue to
evolve and simplify the process.

Quantitative Data Forms

Several quantitative data form templates are provided that allow the user to track the emergence, mastery, and
generalization of the following: 1) a single skill in one individual, 2) multiple skills in one individual, and 3) a
sequence of related skills in one individual.

Emerging Skill Data Form The Emerging Skill Data Form (Appendix Form 1A) is used to record a
child’s ability to demonstrate one targeted skill, with repeated practice, during one specific activity. This type
of data collection is used to monitor initial acquisition of one target skill. Instruction is highly prescriptive and
repetitious using this data collection form. Responses are recorded as correct, prompted, or incorrect. The
level of prompt can be coded as auditory/verbal, visual, gestural, or physical prompt. The data form is
structured to record and then calculate the student’s percentage of correct responses during each lesson or
activity and then to record the level of prompting required. This level of data specificity is beneficial for the
initial stages of skill acquisition, particularly for children who tend to acquire new skills at a slow rate. The
following vignette illustrates a scenario in which an Emerging Skill Data Form could be used. (See Figure 9.1
for a completed Emerging Skill Data Form.)

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Figure 9.1. Emerging Skill Data Form for Charlie.

Charlie is in a co-taught general education classroom. One of Charlie’s objectives is to become more independent in
group activities. He does not follow group directions and waits for an adult or peer to tell him directly what to do. His
objective is to follow routine group directions during activities such as transitions. These directions from his teacher are
the same each day. For the first few weeks, Charlie’s responses were recorded each time a group direction was given
during a transition. One of the teachers recorded his response, the type of prompt used, or if he did not follow the
direction independently. With consistent use of a visual support (e.g., cue card on desk) along with auditory/verbal and
gestural prompts as needed, Charlie began to acquire the skill.

Skill Mastery Data Form The Skill Mastery Data Form (Appendix Form 2A) is used to track mastery of
one targeted skill across multiple instructional activities. The form is used to record a child’s responses to one
specific elicited skill in a number of natural settings targeted for instruction. The skill may be elicited in a
structured or unstructured activity. Responses are coded as correct (i.e., independent), prompted, or
incorrect/no response, with the type of prompting required indicated. The form is used to record data on one
target skill across various natural settings during direct instruction and calculate the child’s percentage of
correct responses to determine skill mastery. The following vignette illustrates a scenario in which a mastery
data form could be used. (See Figure 9.2 for an example of a completed Skill Mastery Data Form.)

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Figure 9.2. Skill Mastery Data Form for Ben.

In school, Ben engages in play and leisure activities next to others but refuses to let peers touch objects that are intended
to be shared. Ben yells when a peer takes an object from his pile. Sharing is a primary learning objective for Ben. The
team planned a way to organize materials so that Ben could see which objects are shared. They put all shared objects
on a red mat between Ben and his peers and then encouraged peers to ask Ben for one of the objects if it was on the red
mat. Different play and leisure activities (e.g., Legos, playdough, blocks) were selected for direct instruction and
progress monitoring. The teachers encouraged peers to ask Ben to share multiple times a day and prompted the desired
response as needed. The Skill Mastery Data Form was used to record Ben’s response to direct instruction. Data on
Ben’s response to instruction were collected for each of the activities on a rotating basis, one day per week. As seen in
Figure 9.2, Ben is showing an increase in spontaneous sharing with the instructional procedure after 3 weeks of direct
instruction.

Skill Generalization Data Form The Skill Generalization Data Form (Appendix Form 3A) can be used
to observe and record a child’s ability to demonstrate a newly mastered social or communication skill
independently during different novel activities or settings where direct instruction did not occur. An example
of data collected to monitor generalization of one target skill can be found in Figure 9.3. The form is

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structured to record generalization of a skill across natural settings where direct instruction did not occur and
to measure the child’s independent skill use. The following vignette illustrates a scenario in which a Skill
Generalization Data Form could be used.

Figure 9.3. Skill Generalization Data Form for Andre.

Andre is a student who receives support from an educational aide in his general education classroom. Andre has become
increasingly dependent on his instructional aide over the past few years due in part to his limited spontaneous
communication. A primary objective for Andre is to ask for help with both his personal belongings and his schoolwork.
Andre acquired the ability to ask for help during three activities that were targeted for direct instruction. In order to
assess Andre’s functional use of the skill, data were collected during other school activities in which direct instruction
did not occur. The data can be used to show 1) whether the skill is being used and 2) where additional instruction is
needed. Andre was able to generalize the skill to other activities in his classroom, but he struggled to use the newly
acquired skill in frustrating situations (see Figure 9.3). Based on the data collected, situations that are frustrating for
Andre will be targeted for direct instruction to support his ability to spontaneously ask for help in all contexts.

Multiple Skills Mastery Data Forms Whereas the previous data collection forms aim to capture the
acquisition of a single skill, the Multiple Skills Mastery Data Forms are used to track the acquisition of

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multiple skills simultaneously (see Appendix Forms 4A and 5A). The first Multiple Skills Mastery Data Form
allows the user to collect data for more than one objective during multiple instructional activities. The second
Multiple Skills Mastery Data Form—Adult and Peer Partners is used to compare skill development with
adult and peer social partners.
The Multiple Skills Mastery Data Form (Appendix Form 4A) can be used to monitor a child’s progress
on two to four different objectives in multiple activities or settings where direct instruction occurs. This type
of data form allows the user to record the child’s responses when multiple skills are being taught and
monitored simultaneously. The direct instruction may occur in multiple structured or unstructured activities
that occur on a daily basis. Similar to the prior data forms used to track a single skill, this data form is
organized to record 1 week of data and the student’s responses to multiple learning opportunities a day. The
data are then scored to calculate the child’s percentage of correct, independent skill use. The following
vignette illustrates a scenario in which this data form could be used to track multiple objectives
simultaneously.

Marcus is working on three social and communication objectives during two play activities in preschool. The team uses
the Multiple Skills Mastery Data Form to identify the percentage of time that he 1) shares toys when asked by an adult
or peer, 2) comments about his play to an adult or peer, and 3) answers What? questions posed by an adult during
play. The adult fills out the data form while engaged in play with the children, indicating whether Marcus displayed
the skill, required prompting to display the skill, or did not respond when prompted the first time. An example of
Marcus’s data can be seen in Figure 9.4. The team reviewed the data, which showed that Marcus relied on verbal
prompts the majority of the time. They used the data to change how they prompted Marcus in order to increase his
independence.

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Figure 9.4. Multiple Skills Mastery Data Form for Marcus.

Another way to measure skill mastery is to monitor a child’s ability to demonstrate new skills with both
adults and peers. The Multiple Skills Mastery Form—Adult and Peer Partners (see Appendix Form 5A) is
specifically designed to track the child’s acquisition of two different skills across multiple activities, with a
focus on comparing the child’s responses to adult and peer partners. The following vignette illustrates a
scenario in which this method of data collection involving multiple skills was used for Jorge.

Jorge is a student in a co-taught classroom. His intervention plan includes acquisition of two different communication
skills that can be targeted for direct instruction, elicited, and practiced in most activities: 1) stating “I don’t know”
when confused and 2) commenting. Jorge’s intervention team wanted to ensure that he was learning to use his
communication skills with both adults and peers. To that end, a data collection form (see Appendix Form 5A) was used
to track the development of his communication skills and compare his skill use with adults and with peers during a
variety of classroom activities, including reading, math, choir, and social skills group. As indicated in Figure 9.5, Jorge
demonstrated his communication skills much more frequently with adults versus peers. These data assisted the team to
increase opportunities for Jorge to communicate with peers and modify the type of prompts used with peers.

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Figure 9.5. Jorge’s Multiple Skills Mastery Data Form—Adult and Peer Partners.

Multiple Skills Generalization Data Forms The Multiple Skills Generalization Data Forms can be used
to track a child’s generalization of two or more newly acquired skills across a variety of novel activities where
direct instruction did not occur and across a variety of social partners. The Appendix includes two forms (see
Appendix Forms 6A and 7A) that can be used to observe and record the child’s ability to demonstrate newly
mastered skills independently. The first Multiple Skills Generalization Data Form (see Appendix Form 6A) is
designed to track skill generalization in any activity or setting where direct instruction did not occur. The
second Multiple Skills Generalization Data Form—Adult and Peer Partners (see Appendix Form 7A) is used
specifically to compare the child’s generalization of newly mastered skills when interacting with both adult
and peer partners. The format and use of these data collection forms to track skill generalization are identical
to the previously discussed methods for monitoring multiple skills targeted for mastery. The difference is that
generalization data are collected in those natural contexts where direct instruction did not occur. These data
forms are particularly useful to monitor students who may acquire new skills rapidly in controlled instructional
activities but may not easily generalize mastered skills to new settings. The following vignette illustrates a
scenario in which data were collected to track multiple skill use across partners and environments to support
generalization of skills.

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Andrea has demonstrated the ability to acquire new communication skills in her one-to-one weekly sessions with the
speech language pathologist. However, both the classroom teachers and Andrea’s parents commented that the skills
Andrea has reportedly “mastered” in speech therapy have not been observed in school or at home. To address the lack of
generalization, the team began to systematically monitor the situations in school in which these newly acquired
communication skills should be observed. The data obtained in novel settings revealed two significant findings: 1)
Andrea was using many of her newly acquired skills, but only with adults; and 2) teachers and parents needed to
practice the skills with Andrea in home and school settings and use similar teaching cues and prompts from her speech
therapy sessions. This information assisted the team in supporting Andrea’s generalization of newly acquired skills. See
Figures 9.6 and 9.7 for examples of the generalization data collected for Andrea.

Figure 9.6. Multiple Skills Generalization Data Form for Andrea.

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Figure 9.7. Andrea’s Multiple Skills Generalization Data Form—Adult and Peer Partners.

Social Task Analysis The DWLS Social Task Analysis is a modified version of a task analysis that is
commonly used to assess and monitor an individual’s ability to complete a task independently. A task analysis
is defined as the process of breaking a skill down into smaller, more manageable components. The process
involves identifying the sequence of steps needed to perform a motor task, such as self-care skills or work
skills, and then assessing what steps the learner can or cannot complete independently (Szidon & Franzone,
2009). The simplest way to create a task analysis is to physically do the task, verbally talk through each step,
and write down the steps in sequential order. Once a task analysis is written, it is used to assess the child’s
ability to complete each step of the task or activity. The child is provided the minimum level of assistance
during the initial assessment. The task analysis list is used to record the level of prompting that he or she
needed to complete each step of the task. This information is then used to determine when and how to give
direct instruction and support. The task analysis list can be used at systematic time intervals to monitor
improvements in the child’s level of independence.
The DWLS Social Task Analysis Form (see Appendix Form 8A) provides space to list the cognitive
(DO), social (WATCH), language (LISTEN), and communication (SAY) skills required to participate in a
specific social activity, and then measure the child’s level of independence with each skill on the list. Similar to
a routine task analysis, a social task analysis is developed by doing a “walk through” of the requirements of a
specific social activity. The Social Task Analysis may or may not be a fixed sequence of steps. The uniqueness

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of the DWLS Social Task Analysis is the separate delineation of the cognitive, social, language, and
communication demands of one activity. This information can be used to better understand the skills that are
limiting the child’s independence and participation in an activity. The DWLS Social Task Analysis identifies
the specific set of skills required to be an active social participant and the type of skill; that is, what to DO,
whom to WATCH, when to respond (LISTEN), and what to communicate (SAY). A sample social task
analysis is shown in Figure 9.8. The DWLS Social Task Analysis Form is used to record the presence of each
skill on the list and the level of prompting required. The same list is used to monitor progress over time, with
a reassessment of current performance weekly or biweekly. The following vignette illustrates a scenario in
which data collection using a social task analysis was used:

Figure 9.8. DO-WATCH-LISTEN-SAY Social Task Analysis Form for Camden.

Camden has significant challenging behaviors during unstructured portions of his school day, specifically at recess. A
part of his behavior intervention plan was an assessment of what social skills were present or lacking at recess. The
assumption was that he had difficulty with transitions and that challenges were more likely to occur at the beginning
and end of recess. The task analysis was created by observing and recording a same-age peer’s basic skills during recess.
The list of skills was coded according to the DWLS framework. An assessment of Camden’s current skills found that he

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was able to play the games during recess (DO), but required some prompting for the social demands (WATCH). He
needed significant prompting for all the communication requirements (SAY). The challenging behaviors were more
likely to occur when communication skills were required. Based on data collected using the Social Task Analysis, an
intervention plan was created, with specific attention given to teaching the communication skills (SAY) needed for
Camden’s increased participation at recess and, indirectly, to reduce his challenging behavior during recess time.

Qualitative Data Forms

The qualitative data forms are templates that allow the user to
• List skills used in natural settings
• Have family members or professionals familiar with the child rate the presence of skills at home, at school,
or in the community

Core Skills Progress Forms With anecdotal observation, the observer records a descriptive account of
behaviors of interest (Cooper, Heron, & Heward, 2007). An anecdotal list of mastered and generalized skills
as they occur in the natural environment is a valid form of progress monitoring. The Chapter 9 Appendix
includes two forms (see Appendix Forms 1B and 2B) that can be used to collect core skill samples specifically
for tracking generalized motor and verbal imitation skills. The Motor Imitation Progress Form (see Appendix
Form 1B) and Verbal Imitation Progress Form (see Appendix Form 2B) are designed to generate qualitative
lists of verbal messages and motor actions that a child spontaneously imitates and to check for the presence
and consistency of those skills across adult and peer partners. The following vignette illustrates a scenario in
which data collection using skill samples was used.

Kent is able to imitate simple motor actions in structured, direct teaching lessons. He is able to imitate actions such as
clapping his hands and tapping his knees during structured lessons, but he is rarely able to imitate simple motor actions
in natural settings. In an effort to conduct direct teaching in natural settings, the teacher used the Motor Imitation
Progress Form (see Figure 9.9) to generate an ongoing list of those actions that Kent has learned to imitate in natural
settings. This log served as a more functional means of documenting Kent’s imitation skills. The teacher quickly
realized that Kent could imitate peers in a group when everyone was doing the same action at the same time.

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Figure 9.9. Motor Imitation Progress Form for Kent.

Kent’s team also sees that he is struggling to imitate sounds and word approximations in structured, direct
teaching lessons. Kent is more likely to imitate sounds and approximate words when physically active. To
capture these data, the teacher used the Verbal Imitation Progress Form (see Figure 9.10) to generate an
ongoing list of word approximations that Kent imitates in natural settings. This log served as a more
functional means of documenting verbal imitation skills.

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Figure 9.10. Verbal Imitation Progress Form for Kent.

Social Skills Progress Forms A running record of observed social skills can be a rich and reliable means to
report progress in different social areas. The Chapter 9 Appendix includes three forms (see Appendix Forms
3B, 4B, and 5B) for reporting progress in solitary play and leisure, social play and leisure, and group skills.
These forms record observations of acquired skills over an extended period of time in a variety of activities and
settings. The Solitary Play and Leisure Progress Form (see Appendix Form 3B) lists the child’s solitary
activities and level of independence. The Social Play and Leisure Progress Form (see Appendix Form 4B) lists
specific social activities, coding the child’s ability to independently demonstrate social skills such as watching,
sharing, taking turns, and responding with both adults and peers. The Group Skills Progress Form (see
Appendix Form 5B) lists specific group activities, coding the child’s ability to attend, wait, take turns, and
follow directions during each activity. Information about the child’s leisure and group skills can be used to
systematically assess ongoing social progress and adapt intervention plans. Intermittent video recording of the
child in various social contexts is recommended as a complementary means of documenting the mastery and
generalization of functional social skills. The following vignette about William explains how a running record
of a child’s solitary play and leisure skills can be done, as illustrated in Figure 9.11.

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Figure 9.11. Solitary Play and Leisure Progress Form for William.

William’s family wants him to expand his solitary play skills at home. He uses his outdoor swing set but has few
interests when indoors. The school team and family taught William to engage in a variety of closed-ended activities
and maintained a list of those activities that he participated in independently. The objective was for William to play
alone independently. By helping William’s family organize his toys and structure his playtime as done in school, the
team helped increase his ability to occupy his time independently at home. The school team and family continued to
explore new toys and activities over time.

The following vignette illustrates a scenario in which data collection using Social Skills Progress Forms
could be used.

Maria’s primary learning objectives are in the areas of social play and group participation. She attends a school that
focuses on developmental play as the context for all learning. The intervention team used Social Play and Leisure
Progress Forms and Group Skills Progress Forms to record Maria’s skills. The team was able to use the data to identify
specific teaching opportunities in each of her daily activities. The team shared the data with Maria’s mother on a
monthly basis. See Figure 9.12 for Maria’s Social Play and Leisure Progress Form and Figure 9.13 for an example of
Maria’s Group Skills Progress Form.

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Figure 9.12. Social Play and Leisure Progress Form for Maria.

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Figure 9.13. Group Skills Progress Form for Maria.

Communication Skills Progress Forms An effective way to monitor an individual’s progress on a specific
communication objective is to keep a running record of all the instances in which the communication skill is
observed. The Communication Generalization Form (see Appendix Form 6B) documents the functional use
of a single communication skill by recording the number of social contexts in which the specific skill is
observed. The following vignette illustrates a scenario in which progress on a specific communication skill was
monitored using the log.

John is a young nonspeaking child who uses an AAC device to make requests and is being taught to sign HELP when
frustrated. John was first taught to ask for help during snack, when he would become frustrated opening his container.
The team found that John quickly learned to use the sign for HELP in this context. There were many other situations in
which John struggled to open or put together or fix something, and he would scream. In each of these situations, John
was taught to request help from an adult. However, even after many months of practice, John did not generalize this
skill to his peers. Using the Communication Generalization Form (see Figure 9.14) to monitor John’s skill
development, the team was able to model how to support John to ask for help with all the adults and peers in his life.
This increased his generalization of the skill across home and school settings and simultaneously decreased his
frustration and screaming.

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Figure 9.14. Communication Generalization Form for John.

Language samples are commonly used to evaluate the grammatical complexity of a child’s expressive
language. A language sample is a written list of verbal messages that an individual says during an observation
period. A similar process can be applied to monitor a child’s progress in communication. A communication
sample (see Appendix Form 7B) provides space to list examples of what the child with autism says (i.e., either
spoken, signed, or via an AAC system) and codes whether the message is directed to an adult or a peer. A
communication sample is a powerful snapshot of the child’s communication abilities and can provide insight
into the types of messages used as well as their communicative functions. The following vignette illustrates a
scenario in which data collection using a communication sample was used:

Augustine uses a combination of speech, sign, and technology (e.g., iPad app) with photos to communicate his needs and
feelings. During each progress period, the team collects a communication sample to show the words in his repertoire and
the purposes of his communication messages. Given that Augustine uses multiple communication systems, the sample
helps to clarify what means of communication he uses and for what purposes. These data help everyone who works with
Augustine to better understand the full range of his communication abilities with both adults and peers. See Figure
9.15 for Augustine’s communication sample.

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Figure 9.15. Communication Sample Form for Augustine.

A conversation transcript (see Appendix Form 8B) is a simple way to record a specific conversation
between a child with autism and one partner. Intermittent audio or video recording of the child is a
complementary means of documenting the mastery and generalization of functional conversational skills. A
sample conversation transcript for a student named Brenda can be seen in Figure 9.16. A conversational
exchange among Brenda, a teacher, and a peer was recorded as part of monitoring Brenda’s progress toward
maintaining two conversational turns during an unstructured conversation.

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Figure 9.16. Conversation Transcript for Brenda.

Social and Communication Skills Rating Scales Rating scales are a valid means to monitor skill
generalization and can be designed to check the independent use of specific social skills in novel settings. The
Appendix includes three examples of rating scales that could be used to track skills across different settings
(see Appendix Forms 9B, 10B, and 11B). The Social Skills Rating Scale (see Appendix Form 9B; see Figure
9.17 for an example) is designed to rate the generalization and functional use of one social skill at home and in
the community. The following vignette illustrates a scenario in which data collection using the Social Skills
Rating Scale was used.

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Figure 9.17. Social Skills Rating Scale for Samantha.

Samantha is able to share toys and materials in school when the team structures playtime in the classroom. In contrast,
her parents report that she continues to disrupt play and leisure activities at home and in the community, frequently
refusing to share with peers and siblings. The parents agreed to spend a month recording Sam’s abilities and difficulties
sharing with her siblings and peers, rating her ability to share during a variety of activities based on whether she
shared spontaneously on her own, needed to be prompted to share, or refused to share. After a few weeks of recording
Sam’s ability to share during different activities, her parents found that she was very successful with some activities
(e.g., table top games and crafts) and had difficulty with others (e.g., unstructured games in which toys are scattered on
the floor, such as Legos or blocks). With this new information, the team was able to help them better support Samantha
in order to generalize her skills to play scenarios that were more challenging for her.

The Multiple Social and Communication Skills Rating Form (see Appendix Form 10B; see Figure 9.18
for an example) is similar in design and rates the generalization of multiple social and communication skills
simultaneously. This method of data collection is particularly useful for families who want to see whether their
child is generalizing skills from school to home. Family members can have a relatively easy way to check for
the presence and consistency of social skills at home and in community settings. The following vignette

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illustrates data collection using the Multiple Social and Communication Skills Rating Form.

Figure 9.18. Multiple Social and Communication Skills Rating Form for Theo.

Theo has mastered virtually all of the targeted skills on his IEP, but his mother is not reporting any social
improvement at home. The team asked the family to complete the Multiple Social and Communication Skills Rating
Form to better understand the discrepancy between Theo’s home and school social skills. The data revealed that Theo
was using many of his newly acquired skills at home and in the community, but he was more successful with his father
and relied on prompting by his mother. The team was able to use the data to provide direct consultation and support to
Theo’s parents to help them understand how to foster Theo’s generalization.

The Communication Skills Rating Scale (see Appendix Form 11B; see Figure 9.19 for an example) can
also be used by family members or educational team members to rate the generalization of one communication
skill. The rating scale is designed to check the independent use of specific communication skills in novel
settings. The following vignette illustrates a scenario in which data collection using the Communication Skills
Rating Scale could be used.

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Figure 9.19. Communication Skills Rating Scale for Samuel.

Samuel enjoys talking about his special interests but often dominates the conversation, sharing irrelevant details that
do not interest his peers. He quickly disengages or ends a conversation related to the ongoing activity or topic of interest
to others. Although Samuel is able to stay on topic during adult-structured conversations, the objective is for Samuel to
generalize this skill to conversations with a small group of peers. Using a 3-point scale, the teachers and speech
therapists rate Samuel’s independent conversational skills during snack and recess, when plenty of natural
conversations occur. Notice that Samuel still requires prompting to stay on topic during both activities and has not yet
generalized the skill. See Figure 9.19 for Samuel’s Communication Skills Rating Scale data. Form 11B in the
Appendix rates one communication skill in up to 10 novel activities.

Ecological Inventory: Community Planning Guide The Community Planning Guide (see Appendix Form
12B) can assist in the design and implementation of an individual-specific, setting-specific intervention plan
to build social skills in the community. The planning guide is divided into three parts:
• Part I: Community Survey. The survey is to be completed by the child’s caregiver to identify the child’s
social and behavioral needs in the targeted community setting. To begin, identify the community setting
that is a challenge for the child with autism. Next, answer the survey questions to assist in developing an

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 intervention plan.
• Part II: Goals and Objectives. Using the information from the survey, identify the skills to be addressed in
the target setting. Write goals that are based on priorities and specific objectives.
• Part III: Intervention Plan. Based on the goals and objectives, create an intervention plan. Using the
information from the survey, design strategies to prepare the child for the target setting. Preparation
includes helping the child compensate for environmental overstimulation and understand social and
communication expectations. The plan also includes preparing the child for “the unexpected” in the
community.

Completed community planning guides for two students with autism, Quinn and Claire, are found in
Figure 9.20.

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Figure 9.20. Community Planning Guides for Quinn and Claire.

USING DATA TO MAKE INTERVENTION DECISIONS

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Interventionists who collect data and review it regularly contribute to children making more measurable
progress (Reeve & Kabot, 2015). Data should always be used to make intervention decisions. This last section
offers some general guidelines for how often to collect data on social and communication skill development
and how to review the data to make informed decisions about intervention.

How to Collect Data

• How many data are enough?
• Does the amount of data vary with the goal and objective?
• Does the amount of data vary depending on the child’s profile?
• How do I collect data while teaching? What do I do with the data?

These are some of the common questions asked with regard to data collection, and, although beyond the
scope of this text, there are many valuable resources that explore these questions in detail (Reeve & Kabot,
2015).
When collecting data on social and communication skills, the primary goal is to find the easiest and most
reliable means to track a child’s social and communication skill development, which is best captured in natural
environments. This requires a meaningful approach to data collection so that the data collected best represent
the child’s progress and can be objectively reviewed to make intervention changes, as needed. The general rule
is to collect data as often as needed to measure growth and assist in changing interventions. For some children
with autism, daily data are required to measure subtle but important changes in emerging skill development.
For others, the rate of growth is rapid and, as such, generalization data will be the most valuable information.
More data are better only when they are reviewed often as a means to improve programming for the
individual. The following guidelines are offered to assist with planning how to collect data:
1. Plan to collect data on all the skills in the child’s intervention plan on a rotating basis so that there is at
least a weekly sample of all the skills. For example, if the intervention plan contains 12 objectives, then
one option would be to collect data on three skills a day on a 4-day rotation.
2. Plan to record a minimum number of data points during each recording period, which means creating
multiple opportunities to elicit and practice the target skill. For example, create between 5 and 10
opportunities to practice a new skill, either during a single activity or across the day.
3. The amount of data is largely determined by the individual’s rate of progress. That is, if the child is not
making progress, more data are needed. More data help determine what is not working and what
instructional changes may be needed. More data may be defined as
• Collecting data more often
• Collecting more detailed kinds of data, such as types of prompts needed
4. Select the data collection system that will be used for the long term. Recognize that the process may
initially feel burdensome but will eventually become embedded into the teaching style and instructional
approach. The progress monitoring process should not interfere with interactions with the child.
5. Balance the use of quantitative and qualitative measures, selecting those measures that best reflect the
ultimate goal of skill generalization. Most interventionists find that the use of Skill Generalization Forms
paired with rating scales completed by the family and school team are a good beginning data collection
system that can be effectively applied for most students. If the student is not making progress on a specific
skill, more systematic and more frequent quantitative data are usually required.
6. Remember that the most critical information to collect regarding social and communication skills is
generalization data. The quantitative and qualitative data on generalized, functional skill use reveals the
benefits of our teaching efforts and can be considered the measure of authentic progress.

How to Review Data

The primary reason to collect data is to determine whether the child is making progress and to evaluate the
effectiveness of the intervention. The data review process is most effective when the team summarizes the
recorded data, visually displays it on a graph, and then discusses the measured changes. The data are converted
into a numerical unit of measurement, typically percentage of correct responses, entered onto a spreadsheet
(e.g., Microsoft Excel), and graphed. Figure 9.21 illustrates a sample graph. The horizontal line of the graph

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represents the dates of data collection, and the vertical line is the measure of the skill or skills being
monitored. Graphing the data helps the team visualize the child’s response to intervention.

Figure 9.21. Communication Skills Graph for Meredith.

Graphs illustrate trends, whether a skill is being acquired, and whether progress is or is not being made.
Graphed data display patterns that give the team information about what interventions are working. A graph
of data moving upward is a visual of a behavior or skill increasing, whereas data moving downward shows the
reduction of a behavior or skill. Data should be reviewed at fixed time intervals. If data are collected daily,
review and graph the data weekly. If data are collected weekly, review and graph monthly. Data on skill
mastery and data on skill generalization should be graphed separately. The following vignette illustrates a
scenario in which a review of collected data contributed to instructional modifications.

Meredith has two communication objectives this progress period: 1) ask for a break when frustrated with schoolwork
and 2) ask wh- questions during a structured reading activity. The Multiple Skills Mastery Data Form was used two
times per week to record the percentage of time Meredith demonstrated these two skills with instructional support.
Once per month, the data were transferred onto a graph and reviewed by the team. As shown in Figure 9.21,
Meredith is showing progress with asking for a break but is not showing progress with asking wh- questions. Based on
the data, the teacher and speech language pathologist collaborated to modify the instructional procedures used to teach
Meredith to ask wh- questions.

SUMMARY
Data drive all decisions in intervention planning for social and communication skill development. The best
data review continually looks for patterns of skill acquisition. Data will reveal the conditions under which the
child with autism is most successful and demonstrates the ability to generalize skills. Data provide powerful
information about what strategies and supports have been most beneficial for social and communication
intervention, for how long and for what target goals. The success of previous interventions can inform future
intervention decisions. With ongoing progress monitoring via assessments (e.g., ASCS-2) and systematic data
collection, the likelihood increases that intervention efforts will produce long-term authentic results.

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Progress Monitoring Forms

A. QUANTITATIVE DATA COLLECTION FORMS

Form 1A: Emerging Skill Data Form
Form 2A: Skill Mastery Data Form
Form 3A: Skill Generalization Data Form
Form 4A: Multiple Skills Mastery Data Form
Form 5A: Multiple Skills Mastery Data Form—Adult and Peer Partners
Form 6A: Multiple Skills Generalization Data Form
Form 7A: Multiple Skills Generalization Data Form—Adult and Peer Partners
Form 8A: DO-WATCH-LISTEN-SAY Social Task Analysis Form

B. QUALITATIVE DATA COLLECTION FORMS

Form 1B: Motor Imitation Progress Form
Form 2B: Verbal Imitation Progress Form
Form 3B: Solitary Play and Leisure Progress Form
Form 4B: Social Play and Leisure Progress Form
Form 5B: Group Skills Progress Form
Form 6B: Communication Generalization Form
Form 7B: Communication Sample Form
Form 8B: Conversation Transcript Form
Form 9B: Social Skills Rating Scale
Form 10B: Multiple Social and Communication Skills Rating Form
Form 11B: Communication Skills Rating Scale
Form 12B: Community Planning Guide

DO-WATCH-LISTEN-SAY: Social and Communication Intervention for Autism Spectrum Disorder, Second Edition, by Kathleen Ann Quill and L.
Lynn Stansberry Brusnahan. Copyright © 2017 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

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References

Adamek, L., Nichols, S., Tetenbaum, S.P., Bregman, J., Ponzio, C.A., & Carr, E.G. (2011). Individual temperament and problem behavior in
children with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 26, 173–183.
Adams, C. (2002). Practitioner review: The assessment of language pragmatics. Journal of Child Psychology and Psychiatry, 43, 973–987.
Adamson, L.B., Bakeman, R., Deckner, D.F., & Romski, M. (2009). Joint engagement and the emergence of language in children with autism
and Down syndrome. Journal of Autism and Developmental Disorders, 39, 84–96.
AFIRM Team. (2015). Peer-mediated instruction and intervention. Chapel Hill: National Professional Development Center on Autism
Spectrum Disorders, FPG Child Development Center, University of North Carolina.
Alberto, P.A., & Troutman, A.C. (2016). Applied behavior analysis for teachers. New York, NY: Pearson.
Aldred, C., Green, J., & Adams, C. (2004). A new social communication intervention for children with autism: Pilot randomized controlled
treatment study suggesting effectiveness. Journal of Child Psychology and Psychiatry, 45(8), 1420–1430.
American Academy of Pediatrics. (n.d.). Ages & stages. Retrieved from http://agesandstages.com/about-asq/who-uses-asq/pediatricians/
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., revised). Washington, DC: Author.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
American Speech-Language-Hearing Association. (n.d.). Autism evidence map. Retrieved from
http://www.asha.org/EvidenceMapLanding.aspx?id=8589936324&recentarticles=false&year=undefined&tab=all
American Speech-Language-Hearing Association. (2005). Evidence-based practice in communication disorders. Joint Coordinating Committee on
Evidence-Based Practice. Position Statement. Retrieved from http://www.asha.org/policy/PS2005-00221.htm
Anderson, A., Moore, D.W., Godfrey, R., & Fletcher-Flinn, C.M. (2004). Social skills assessment of children with autism in free-play
situations. Autism, 8, 369–385.
Anderson, M.A., Silvestri, S.M., Allen, N.J., Murphy, C.M., Wood, C.L., & Heward, W.L. (2009). Assessing and teaching imitation skills. In
E.A. Boutot & M. Tincani (Eds.), Autism encyclopedia: The complete guide to autism spectrum disorders (pp. 209–216). Waco, TX:
Prufrock Press.
Asperger, H. (1944). Die “Autistischen Psychopathen” in Kindesalter. European Archives of Psychiatry and Clinical Neuroscience, 117(1), 76–136.
Assistive Technology Act Amendments of 2004, PL 108-364, 29 U.S.C. §§ 3001 et seq.
Association for Science in Autism Treatment. (n.d.). Autism interventions. Retrieved from http://www.asatonline.org/
Attwood, T. (2003). Learning and behaviour problems in Aspergers syndrome. New York, NY: Guilford Press.
Autism Focused Interventions and Resources (AFIRM) Modules. (n.d.). Retrieved from http://afirm.fpg.unc.edu/afirm-modules
Autism Internet Modules. (n.d.). Ohio Center for Autism and Low Incidence (OCALI). Retrieved from http://www.autisminternetmodules.org/
Autism Society. (n.d.). History. Retrieved from http://www.autism-society.org/about-the-autism-society/history/
Autism Speaks. (n.d.). Brain research. Retrieved from https://www.autismspeaks.org/site-wide/brain-research
Baer, D.M., Wolf, M.M., & Risley, T.R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis,
1(1), 91–97.
Baker, A., Lane, A., Angley, M.T., & Young, R.L. (2008). The relationship between sensory processing patterns and behavioural
responsiveness in autistic disorder: A pilot study. Journal of Autism and Developmental Disorders, 38(5), 867–875.
Baker, M.J. (2000). Incorporating the thematic ritualistic behaviors of children with autism into games: Increasing social play interactions.
Journal of Positive Behavior Interventions, 2(2), 66–84.
Baranek, G.T., Watson, L.R., Boyd, B.A., Poe, M.D., David, F.J., &. McGuire, L. (2013). Hyperresponsive to social and nonsocial sensory
stimuli in children with autism, child with developmental delays and typically developing children. Development and Psychopathy, 25(2), 307–
320.
Baron, C.M., Groden, J., Groden, G., & Lipsitt, L.P. (2006). Stress and coping in autism. Oxford, United Kingdom: Oxford University Press.
Baron-Cohen, S. (2009). Autism: The empathizing-systemizing (E-S) theory. The year in cognitive neuroscience 2009. Annals of the New York
Academy of Sciences, 1156, 68–80.
Baron-Cohen, S., Leslie, A.M., & Frith, U. (1985). Does the autistic child have a “theory of mind”? Cognition, 21, 37–56.
Baron-Cohen, S., Tager-Flusberg, H., & Cohen, D.J. (Eds.). (2000). Understanding other minds: Perspectives from developmental cognitive
neuroscience (2nd ed.). Oxford, United Kingdom: Oxford University Press.
Barron, J. & Barron, S. (1992). There’s a boy in here. New York, NY: Simon & Schuster.
Bartman, S., & Freeman, N. (2003). Teaching language to a two-year-old with autism. Journal on Developmental Disabilities, 10, 47–53.
Barton, E.E., & Pavilanis, R. (2012). Teaching pretend play to young children with autism. Young Exceptional Children, 15(1), 5–17.
Bates, E. (1976). Language in context: The acquisition of pragmatics. San Diego, CA: Academic Press.
Bauminger, N., & Kasari, C. (2000). Loneliness and friendship in high-functioning children with autism. Child Development, 71, 447–456.
Bauminger, N., Shulman, C., & Agam, G. (2003). Peer interaction and loneliness in high-functioning children with autism. Journal of Autism
and Developmental Disorders, 33, 489–507.
Bauminger, N., Solomon, M., Aviezer, A., Heung, K., Brown, J., & Rogers, S.J. (2008). Friendships in high-functioning children with autism
spectrum disorder: Mixed and non-mixed dyads. Journal of Autism and Developmental Disorders, 38, 1211–1229.
Bauminger-Zviely, N., & Agam-Ben-Artzi, G. (2014). Young friendship in HFASD and typical development: Friend versus non-friend
comparisons. Journal of Autism and Developmental Disorders, 44(7), 1733–1748.
Beauchamp, M.H., & Anderson, V. (2010). SOCIAL: An integrative framework for the development of social skills. Psychological Bulletin,
136(1), 39–64.

322
Beauchesne, M.A., & Kelley, B.R. (2004). Evidence to support parental concerns as an early indicator of autism in children. Pediatric Nursing,
30(1), 57.
Bellini, S. (2006). Building social relationships: A systematic approach to teaching social interaction skills to children and adolescents with autism spectrum
disorders and other social difficulties. Autism social skills profile (pp. 77-81). Shawnee Mission, KS: Autism Asperger Publishing.
Berger, H.J., Aerts, F.H., van Spaendonck, K.P., Cools, A.R., & Teunisse, J.P. (2003). Central coherence and cognitive shifting in relation to
social improvement in high-functioning young adults with autism. Journal of Clinical and Experimental Neuropsychology, 25(4), 502–511.
Bettelheim, B. (1967). The empty fortress: Infantile autism and the birth of the self. New York, NY: Free Press.
Betz, A., Higbee, T.S., & Reagon, K.A. (2008). Using joint activity schedules to promote peer engagement in preschoolers with autism. Journal
of Applied Behavior Analysis, 41(2), 237–241.
Bhat, A., Galloway, J., & Landa, R. (2012). Relation between early motor delay and later communication delay in infants at risk for autism.
Infant Behavior and Development, 35(4), 838–846.
Birch, J. (2003). Congratulations! It’s Asperger’s syndrome. London, United Kingdom: Jessica Kingsley.
Bishop, S.L., Richler, J., & Lord, C. (2006). Association between restricted and repetitive behaviors and nonverbal IQ in children with autism
spectrum disorders. Child Neuropsychology, 12, 247–267.
Blair, R.J.R. (2003). Facial expressions, their communicatory functions, and neuro-cognitive substrates. Philosophical Transactions of the Royal
Society of London Series B, 358, 561–572.
Bloom, L. (1993). The transition from infancy to language. New York, NY: Cambridge University Press.
Blum-Kulka, S., & Snow, C.E. (2004). Introduction: The potential of peer talk. Discourse Studies, 6, 291.
Bodfish, J. (2011). Restricted repetitive behaviors. In E. Hollander, A. Kolevzon, & J. Coyle (Eds.), Textbook of autism spectrum disorders (pp.
169–178). Arlington, VA: American Psychiatric Publishing.
Bodfish, J.W., Symons, F.J., Parker, D.E., & Lewis, M.H. (2000). Varieties of repetitive behavior in autism: Comparison to mental retardation.
Journal of Autism and Developmental Disabilities, 30, 237–243.
Bogin, J., & Sullivan, L. (2009). Overview of differential reinforcement of other behaviors. Sacramento, CA: The National Professional
Development Center on Autism Spectrum Disorders, M.I.N.D. Institute, University of California at Davis School of Medicine.
Bölte, S., Holtmann, M., Poustka, F., Scheurich, A., & Schimdt, L. (2007). Gestalt perception and local-global processing in high-functioning
autism. Journal of Autism and Developmental Disorders, 37(8), 1493–1504.
Bondy, A. (2012). The unusual suspects: myths and misconceptions associated with PECS. The Psychological Record, 62(4), 789–816.
Bondy, A., & Frost, L. (2001). A picture’s worth: PECS and other visual communication strategies in autism. Bethesda, MD: Woodbine House.
Bono, M., Daley, T., & Sigman, M. (2004, October). Relations among joint attention, amount of intervention and language gain in autism.
Journal of Autism and Developmental Disorders, 34(5), 495–505.
Boucher, J. (2012). Research review: Structural language in autistic spectrum disorder—Characteristics and causes. Journal of Child Psychology
and Psychiatry, 53, 219–233.
Boutros, N.N., Lajiness-O’Neill, R., Zillgitt, A., Richard, A.E., & Bowyer, S.M. (2015). EEG changes associated with autism spectrum
disorders. Neuropsychiatric Electrophysiology, 1(3). Retrieved from https://npepjournal.biomedcentral.com/articles/10.1186/s40810-014-0001-5
Bowers, L., Huisingh, R., Barrett, M., Orman, J., & LoGiudice, C. (1994). Test of Problem Solving–Elementary, Revised (TOPS-E, Revised).
East Moline, IL: LinguiSystems.
Bowers, L., Huisingh, R., & LoGiudice, C. (2005). Test of Problem Solving 3–Elementary. East Moline, IL: LinguiSystems.
Bowers, L., Huisingh, R., & LoGiudice, C. (2007). Test of Problem Solving 2–Adolescent. East Moline, IL: LinguiSystems.
Boyd, B.A., McBee, M., Holtzclaw, T., Baranek, G.T., & Bodfish, J.W. (2009). Relationships among repetitive behaviors, sensory features,
and executive functions in high functioning autism. Research in Autism Spectrum Disorders, 3(4), 959–966.
Boyd, B.B., Conroy, M.A., Mancil, R., Nakao, T., & Alter, P.J. (2007). Effects of circumscribed interests on the social behaviors of children
with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37(8), 1550–1561.
Brazelton, T.B. (1994). Touchpoints: Your child’s emotional and behavioral development. Reading, MA: Addison Wesley Longman.
Brigance, A.H. (2010). Brigance Transition Skills Inventory. North Billerica, MA: Curriculum Associates.
Brigance, A.H. (2012). Brigance Inventory of Early Development III Criterion-Referenced. North Billerica, MA: Curriculum Associates.
Brigance, A.H., & French, B.F. (2013). Brigance Inventory of Early Development III Standardized. North Billerica, MA: Curriculum Associates.
Brock, M.E., Freuler, A., Baranek, G.T., Watson, L.R., Poe, M.D., & Sabatino, A. (2012). Temperament and sensory features of children
with autism. Journal of Autism and Developmental Disorders, 42(11), 2271–2284.
Broomfield, L., McHugh, L., & Reed, P. (2008). Re-emergence of under-selected stimuli, after the extinction of over-selected stimuli in an
automated match to samples procedure. Research in Developmental Disabilities, 29, 503–512.
Brosnan, M.J., Scott, F.J., Fox, S., & Pye, J. (2004). Gestalt processing in autism: Failure to process perceptual relationships and the
implications for contextual understanding. Journal of Child Psychology and Psychiatry and Allied Disciplines, 45(3), 459–469.
Bruinsma, Y., Koegel, R.L., & Koegel, L.K. (2004). Joint attention and children with autism: A review of the literature. Mental Retardation and
Developmental Disabilities Research Reviews, 10, 169–175.
Brunsdon, V., & Happé, F. (2013). Exploring the “fractionation” of autism at the cognitive level. Autism, 18(1), 17–30.
Buggey, T., Hoomes, G., Sherberger, M.E., & Williams, S. (2011). Facilitating social initiations of preschoolers with autism spectrum
disorders using video self-modeling. Focus on Autism and Other Developmental Disorders, 26(1), 25–36.
Cacioppo, J.T. (2002). Social neuroscience: Understanding the pieces fosters understanding the whole and vice versa. American Psychologist, 57,
819–831.
Carlson, S.M. (2009). Social origins of executive function development. In C. Lewis & J.I.M. Carpendale (Eds.), Social interaction and the
development of executive function. New Directions in Child and Adolescent Development, 123, 87–97.
Carter, E.W., Cushing, L.S., Clark, N.M., & Kennedy, C.H. (2005). Effects of peer support interventions on students’ access to the general
curriculum and social interactions. Research and Practice for Persons with Severe Disabilities, 30(1), 15–25.
Carter, E.W., Sisco, L.G., Chung, Y., & Stanton-Chapman, T.L. (2010). Peer interactions of students with intellectual disabilities and/or
autism: A map of the intervention literature. Research & Practice for Persons with Severe Disabilities, 35, 36–79.
Center for Applied Special Technology. (n.d.). About universal design for learning. Retrieved from www.cast.org
Castelli, F. (2005). Understanding emotions from standardized facial expressions in autism and normal development. Autism, 9, 428–449.
Centers for Disease Control and Prevention. (n.d.). Developmental milestones. Retrieved from
https://www.cdc.gov/ncbddd/actearly/pdf/parents_pdfs/milestonemomentseng508.pdf
Centers for Disease Control and Prevention. (2014). Prevalence of autism spectrum disorders among children aged 8 years: Autism and
developmental disabilities monitoring network, 11 sites, United States, 2010. Morbidity and Mortality Weekly Report (MMWR) Surveillance
Summaries, 63(2), 1–22.
Chakrabarti, S., & Fombonne, E. (2005). Pervasive developmental disorders in preschool children: Confirmation of high prevalence. American
Journal of Psychiatry, 162, 1133–1141.
Chamberlain, B., Kasari, C., & Rotheram-Fuller, E. (2007). Involvement or isolation? The social networks of children with autism in regular
classrooms. Journal of Autism and Developmental Disorders, 37(2), 237–242.
Charman, T. (1997). The relationship between joint attention and pretend play in autism. Development and Psychopathology, 9, 1–16.

323
Chawarska, K., Klin, A., Paul, R., & Volkmar, F. (2007). Autism spectrum disorder in the second year: Stability and change in syndrome
expression. The Journal of Child Psychology and Psychiatry, 48, 128–138.
Chen, Y., Rodgers, J., & McConachie, H. (2009). Restricted and repetitive behaviours, sensory processing and cognitive style in children with
autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(4), 635–642.
Chiang, C., Soong, W., Lin, T., & Rogers, S.J. (2008). Nonverbal communication skills in young children with autism. Journal of Autism and
Developmental Disorders, 38, 1898.
Cihak, D.F. (2011). Comparing pictorial and video modeling activity schedules during transitions for students with autism spectrum disorders.
Research in Autism Spectrum Disorders, 5(1), 433–441.
Clark, H.H. (2008). Pragmatics of language performance. In L.R. Horn & G. Ward (Eds.), The handbook of pragmatics (pp. 365–382). Oxford,
United Kingdom: Blackwell.
Clements, J., & Zarkowska, E. (2000). Behavioural concerns and autistic spectrum disorders: Explanations and strategies for change. London: Jessica
Kingsley Publishers.
Clifford, S.M., & Dissayanake, C. (2008). The early development of joint attention in infants with autistic disorder using home video
observations and parental interview. Journal of Autism and Developmental Disorders, 38, 791–805.
Collet-Klingenberg, L. (2008). Overview of Picture Exchange Communication System (PECS) for children and youth with autism spectrum disorders.
Madison: University of Wisconsin, Waisman Center, The National Professional Development Center on Autism Spectrum Disorders.
Collet-Klingenberg, L., & Franzone, E. (2008). Overview of social narratives. Madison: University of Wisconsin, Waisman Center, The
National Professional Development Center on Autism Spectrum Disorders.
Constable, S., Grossi, B., Moniz, A., & Ryan, L. (2013). Meeting the common core state standards for students with autism spectrum
disorders. TEACHING Exceptional Children, 45(3), 6–13.
Constantino, J.N., Davis, S.A., Todd, R.D., Schindler, M.K., Gross, M.M., Brophy, S.L.,…& Reich, W. (2003). Validation of a brief
quantitative measure of autistic traits: Comparison of the Social Responsiveness Scale with the Autism Diagnostic Interview–Revised. Journal
of Autism and Developmental Disorders, 33(4), 427–433.
Constantino, J.N., & Gruber, C.P. (2012). Social Responsiveness Scale (2nd ed.). Los Angeles, CA: Western Psychological Services.
Conture, E.G., Kelly, E.M., & Walden, T.A. (2013). Temperament, speech and language: An overview. Journal of Communication Disorders,
46(2), 125–142.
Cook, B., Tankersley, M., Cook, M., & Landrum, T. (2008). Evidence-based practices in special education: Some practical consideration.
Intervention in School and Clinic, 44(4), 69–75.
Cook, J.L., & Bird, G. (2012). Atypical social modulation of imitation in autism spectrum conditions. Journal of Autism and Developmental
Disorders, 42(6), 1045–1051.
Coolican, J., Bryson, S., & Zwaigenbaum, L. (2008). Brief report: Data on the Stanford–Binet Intelligence Scales (5th ed.) in children with
autism spectrum disorder. Journal of Autism and Developmental Disorders, 38, 190–197.
Cooper, J.O., Heron, T.E., & Heward, W.L. (2007). Applied behavior analysis. Upper Saddle River, NJ: Pearson Merrill Prentice Hall.
Corbett, B.A., Constantine, L.J., Hendren, R., Rocke, D., & Ozonoff, S. (2009). Examining executive functioning in children with autism
spectrum disorder, attention deficit hyperactivity disorder and typical development. Psychiatry Research, 166(2/3), 210–222.
Council for Exceptional Children. (2014). Council for Exceptional Children standards for evidence-based practices in special education. Retrieved
from http://www.cec.sped.org/~/media/Files/Standards/Evidence%20based%20Practices%20and%20Practice/EBP%20FINAL.pdf
Council for Exceptional Children Interdivisional Research Group. (2014). Evidence-based special education in the context of scare evidence-
based practices: The Council for Exceptional Children’s Interdivisional Research Group. TEACHING Exceptional Children, 47(2), 81–84.
Cox, A.W. (2013). Prompting (PP) fact sheet. Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development
Institute, The National Professional Development Center on Autism Spectrum Disorders.
Crais, E., & Ogletree, B.T. (2016). Prelinguistic communication development. In D. Keen, J. Meadan, N.C. Brady, & J.W. Halle (Eds.),
Prelinguistic and minimally verbal communicators on the autism spectrum (pp. 9–32). New York, NY: Springer.
Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J.,…& Varley, J. (2010). Randomized, controlled trial of an intervention
for toddlers with autism: The Early Start Denver Model. Pediatrics, 125(1), 17–23.
Dawson, G., Toth, K., Abbott, R., Osterling, J., Munson, J., Estes, A., & Liaw, J. (2004). Early social attention impairments in autism: Social
orienting, joint attention, and attention to distress. Developmental Psychology, 40(2), 271–283.
DeMyer, M.K. (1975). The nature of neuropsychological disability in autistic children. Journal of Autism and Childhood Schizophrenia, 5, 109–
128.
de Villiers, J., Fine, J., Ginsberg, G., Vaccarella, L., & Szatmari, P. (2007). Brief report: A scale for rating conversational impairment in autism
spectrum disorder. Journal of Autism and Developmental Disorders, 37, 1375–1380.
Desha, L., Ziviani, J., & Rodgers, S. (2003). Play preferences and behavior of preschool children with autistic spectrum disorder in the clinical
environment. Physical & Occupational Therapy in Pediatrics, 23, 21–42.
Dewey, D., Cantell, M., & Crawford, S.G. (2007). Motor and gestural performance in children with autism spectrum disorders, developmental
coordination disorder, and/or attention deficit hyperactivity disorder. Journal of the International Neuropsychological Society, 13, 246–256.
DiLavore, P.C., Lord, C., & Rutter, M. (1995). The Pre-Linguistic Autism Diagnostic Observation Schedule (PL-ADOS). Journal of Autism
and Development Disorders, 25, 355–379.
Donkers, F.C.L., Schipul, S.E., Baranek, G.T., Cleary, K.M., Willoughby, M.T., Evans, A.M.,…& Belger, A. (2015). Attenuated auditory
event-related potentials and associations with atypical sensory response patterns in children with autism. Journal of Autism and Developmental
Disorders, 45(2), 506–523.
Douglas, S., & Stirling, L. (Eds.). (2016). Children’s play, pretense, and story: Studies in culture, context, and autism spectrum disorder. London,
United Kingdom: Routledge.
Drew, A., Baird, G., Baron-Cohen, S., Cox, A., Slonims, V., Wheelwright, S.,…& Charman, T. (2002). A pilot randomised control trial of a
parent training intervention for pre-school children with autism. European Child and Adolescent Psychiatry, 11, 266–272.
Dunn-Buron, K. (2012). Incredible 5 Point Scale: The significantly improved and expanded second edition. Assisting students in understanding social
interactions and controlling their emotional responses. Shawnee Mission, KS: Autism Asperger Publishing.
Dykens, E.M., & Lense, M. (2011). Intellectual disabilities and autism spectrum disorders: A cautionary note. In D. Amaral, G. Dawson, & D.
Geschwind (Eds.), Autism spectrum disorders (pp. 261–269). New York, NY: Oxford University Press.
Dyches, T.T., Wilder, L.K., Sudweeks, R.R., Obiakor, F.E., & Algozzine, B. (2004). Multicultural issues in autism. Journal of Autism and
Developmental Disorders, 34, 211–222.
Dziuk, M.A., Larson, J.C.G., Apostu, A., Mahone, E.M., Denckla, M.B., & Mostofsky, S.H. (2007). Dyspraxia in autism: Association with
motor, social, and communicative deficits. Developmental Medicine and Child Neurology, 49, 734–739.
Eack, S., Mazefsky, C., & Minshew, N. (2015). Misinterpretation of facial expressions of emotion in verbal adults with autism spectrum
disorder. Autism, 19(3), 308–315.
Education for All Handicapped Children Act of 1975, PL 94-142, 20 U.S.C. §§ 1400 et seq.
Eimas, P. (1996). The perception and representation of speech by infants. In J. Morgan & K. Demuth (Eds.), Signal to syntax: Bootstrapping
from speech to grammar in early acquisition (pp. 25–39). Mahwah, NJ: Lawrence Erlbaum Associates.

324
Every Student Succeeds Act (ESSA) of 2015, PL 114-95, 20 U.S.C. §§ 1177 et seq. Retrieved from
https://www.govtrack.us/congress/bills/s1177
Ferraioli, S.J., & Harris, S.L. (2011). Effective inclusion of students on the autism spectrum. Journal of Contemporary Psychotherapy, 41(1), 19–
28.
Filipek, P.A., Accardo, P.J., Ashwal, S., Baranek, G.T., Cook, E.H., Jr., Dawson, G.,…& Volkmar, F.R. (2000). Practice parameter: screening
and diagnosis of autism. Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology
Society. Neurology, 55(4), 468–479.
FIRST WORDS Project. (2014). 16 Gestures by 16 Months. 16 by 16 Series. Retrieved from www.firstwordsproject.com
Fisher, N., & Happé, F. (2005). A training study of theory of mind and executive function in children with autism spectrum disorders. Journal
of Autism and Developmental Disorders, 35(6), 757–771.
Fleury, V.P. (2013a). Scripting (SC) fact sheet. Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development
Institute, The National Professional Development Center on Autism Spectrum Disorders.
Fleury, V.P. (2013b). Time delay (TD) fact sheet. Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development
Institute, The National Professional Development Center on Autism Spectrum Disorders.
Forest, M., & Lusthaus, E. (1990). Everyone belongs with MAPS action planning system. TEACHING Exceptional Children, 22, 32–35.
Fournier, K.A., Hass, C.J., Naik, S.K., Lodha, N., & Cauraugh, J.H. (2010). Motor coordination in autism spectrum disorders: A synthesis and
metaanalysis. Journal of Autism and Developmental Disorders, 40, 1227–1240.
Fox, J.E. (2007). Back-to-basics: Play in early childhood. Early Childhood News. Retrieved from
http://www.earlychildhoodnews.com/earlychildhood/article_view.aspx?ArticleID=240
Franco, J.H., Davis, B.L., & Davis, J.L. (2013, August). Increasing social interaction using prelinguistic milieu teaching with nonverbal school-
age children with autism. American Journal of Speech-Language Pathology, 22(3), 489–502.
Franzone, E. (2009). Overview of naturalistic intervention. Madison: University of Wisconsin, Waisman Center, The National Professional
Development Center on Autism Spectrum Disorders.
Franzone, E., & Collet-Klingenberg, L. (2008a). Overview of speech generating devices for children and youth with autism spectrum disorders.
Madison: University of Wisconsin, Waisman Center, The National Professional Development Center on Autism Spectrum Disorders.
Franzone, E., & Collet-Klingenberg, L. (2008b). Overview of video modeling. Madison: University of Wisconsin, Waisman Center, The
National Professional Development Center on Autism Spectrum Disorders.
Freeth, M., Bullock, T., & Milne, E. (2013). The distribution of and relationship between autistic traits and social anxiety in a UK student
population. Autism, 17(5), 571–581.
Frith, C.D., & Frith, U. (2012). Mechanisms of social cognition. Annual Review of Psychology, 63, 287–313.
Frith, U. (2001). Mind blindness and the brain in autism. Neuron, 32, 969–979.
Frith, U. (2008). Autism: A short introduction. New York, NY: Oxford University Press.
Frith, U. (2012). Why we need cognitive explanations of autism. Quarterly Journal of Experimental Psychology, 65(11), 2073–2092.
Franco, J.H., Davis, B.L., & Davis, J.L. (2003). Increasing social interaction using prelinguistic milieu teaching with nonverbal school-age
children with autism. American Journal of Speech-Language Pathology, 22, 489–502.
Frost, L.A., & Bondy, A.S. (2002). The Picture Exchange Communication System training manual (2nd ed.). Newark, DE: Pyramid Educational
Consultants.
Gabriels, R.L., Cuccaro, M.L., Hill, D.E., Ivers, B.J., & Goldson, E. (2005). Repetitive behaviors in autism: Relationships with associated
clinical features. Research in Developmental Disabilities, 26(2), 169–181.
Gadow, K.D., DeVincent, C.J., Pomeroy, J., & Azizian, A. (2004). Psychiatric symptoms in preschool children with PDD and clinic and
comparison samples. Journal of Autism and Developmental Disorders, 34(4), 79–93.
Garcia-Winner, M. (2015). Solving problems before they become problems. Think Social Publishing. Retrieved from
https://www.socialthinking.com
Garfinkle, A.N., & Schwartz, I.S. (2002). Peer imitation: Increasing social interactions in children with autism and other developmental
disabilities in inclusive preschool classrooms. Topics in Early Childhood Special Education, 22(1), 26–38.
Garvey, C. (1977). Play. Cambridge, MA: Harvard University Press.
Genqoux, G.W. (2015). Priming for social activities: Effects on interactions between children with autism and typically developing peers.
Journal of Positive Behavior Interventions, 17(3), 181–192.
Gessaroli, E., Santelli, E., di Pellegrino, G., & Frassinetti, F. (2013). Personal space regulation in childhood autism spectrum disorders. PLoS
One, 8(9), e74959.
Geurts, H.M., Corbett, B., & Solomon, M. (2009). The paradox of cognitive flexibility in autism. Trends in Cognitive Sciences, 13, 74–82.
Geurts, H.M., Verté, S., Oosterlaan, J., Roeyers, H., & Sergeant, J.A. (2004). How specific are executive functioning deficits in attention
deficit hyperactivity disorder and autism? Journal of Child Psychology and Psychiatry, 45(4), 836–854.
Ghaziuddin, N., Dhossche, D., & Marcotte, K. (2012). Retrospective chart review of catatonia in child and adolescent psychiatric patients. Acta
Psychiatrica Scandinavica, 125(1), 33–38.
Giangreco, M.F., Cloninger, C.J., & Iverson, V.S. (2011). Choosing Outcomes and Accommodations for Children (COACH): A guide to
educational planning for students with disabilities (3rd ed.). Baltimore, MD: Paul H. Brookes Publishing Co.
Gidley Larson, J., & Mostofsky, S. (2006). Motor deficits in autism. In R. Tuchman & I. Rapin, (Eds.). Autism: A neurological disorder of early
brain development. London, United Kingdom: MacKeith Press.
Gifford-Smith, M.E., & Brownell, C.A. (2003). Childhood peer relationships: Social acceptance, friendships, and peer networks. Journal of
School Psychology, 41, 235–284.
Ginsburg, K.R. (2007). The importance of play in promoting healthy child development and maintaining strong parent-child bonds. Pediatrics,
119(1), 182–191.
Gioia, G.A., Isquith, P.K., Guy, S.C., & Kenworthy, L. (2013). BRIEF: Behavior Rating Inventory of Executive Function. Lutz, FL:
Psychological Assessment Resources.
Gioia, G.A., Isquith, P.K., Kenworthy, L., & Barton, R.M. (2002). Profiles of everyday executive function in acquired and developmental
disorders. Child Neuropsychology, 8, 121–137.
Golan, O., & Baron-Cohen, S. (2012). Systemizing empathy: Teaching adults with Asperger syndrome or high-functioning autism to
recognize complex emotions. Developmental and Psychopathology, 18(2), 591–617.
Golan, O., Baron-Cohen, S., & Golan, Y. (2008). The “reading the minds in films” task [Child version]: Complex emotion and mental state
recognition in children with and without autism. Journal of Autism and Developmental Disorders, 38(8), 1534–1541.
Gonsiorowski, A., Williamson, R.A., & Robins, D.L. (2016). Brief report: Imitation of object-directed acts in young children with autism
spectrum disorders. Journal of Autism and Developmental Disorders, 46, 691.
Goodwyn, S.W., Acredolo, L.P., & Brown, C.A. (2000). Impact of symbolic gesturing on early language development. Journal of Nonverbal
Behavior, 24, 81–103.
Grandin, T. (1995). Thinking in pictures and other reports from my life with autism. New York, NY: Doubleday.
Grandin, T. (2009). How does visual thinking work? A personal account. Philosophical Transactions: Biological Sciences, 364(1522), 1437–1442.

325
Grandin, T. (2011). The way I see it: A personal look at autism & Asperger’s (2nd ed.). Arlington, TX: Future Horizons.
Gray, C. (1994). Comic strip conversations. Arlington, TX: Future Horizons.
Gray, C. (2010). The new social story book, revised and expanded 10th anniversary edition. Arlington, TX: Future Horizons.
Green, D., Baird, D., Barnett, A.L., Henderson, L., Huber, J., & Henderson, S.E. (2002). The severity and nature of motor impairment in
Asperger’s syndrome: A comparison with specific developmental disorder of motor function. Journal of Child Psychology & Psychiatry, 43(5),
655–668.
Greenspan, S. (1992). Infancy and early childhood: The practice of clinical assessment and intervention with emotional and developmental challenges.
Madison, CT: International Universities Press.
Greenspan, S., & Wieder, S. (2006). Engaging autism: Using the Floortime approach to help children relate, communicate, and think. Cambridge,
MA: Da Capo Press.
Greenway, C. (2000). Autism and Asperger syndrome: Strategies to promote prosocial behaviours. Educational Psychology in Practice, 16(4),
469–486.
Gresham, F.M., & Elliot, S.N. (1990). The Social Skills Rating System (SSRS). Circle Pines, MN: American Guidance Service.
Gresham, F.M., & Elliott, S.N. (2008). Social Skills Improvement System Rating Scales (SSIS). Minneapolis, MN: NCS Pearson.
Hagerman, R.J., Rivera, S.M., & Hagerman, P.J. (2008). The fragile X family of disorders: A model for autism and targeted treatments.
Current Pediatric Reviews, 4, 40–52.
Hanley, M., Riby, D.M., McCormack, T., Carty, C., Coyle, L. Crozier, N.,…& McPhillips, M. (2014). Attention during social interaction in
children with autism: Comparison to specific language impairment, typical development, and links to social cognition. Research in Autism
Spectrum Disorders, 8, 908–924.
Happé, F. (2003). Theory of mind and the self. Annals of the New York Academy of Sciences, 1001, 134–144.
Happé, F., & Frith, U. (2006). The weak coherence account: Detail-focused cognitive style in autism spectrum disorders. Journal of Autism and
Developmental Disorders, 36(1), 5–25.
Happé, F., & Ronald, A. (2008). The ‘fractionable autism triad’: A review of evidence from behavioural, genetic, cognitive and neural research.
Neuropsychology Review, 18, 287–304.
Happé, F., Ronald, A., & Plomin, R. (2006). Time to give up on a single explanation for autism. Nature Neuroscience, 9, 1218–1220.
Harms, M.B., Martin, A., & Wallace, G.L. (2010). Facial emotion recognition in autism spectrum disorders: A review of behavioral and
neuroimaging studies. Neuropsychology Review, 20(3), 290–322.
Harris, S., Handleman, J., & Burton, J. (1990). The Stanford-Binet profiles of young children with autism. Special Services in the School, 6, 135–
143.
Harrison, P., & Oakland, T. (2015). Adaptive Behavior Assessment System, Third Edition (ABAS-3). Torrance, CA: Western Psychological
Services.
Hart, B., & Risley, T.R. (1982). How to use incidental teaching for elaborating language. Austin, TX: PRO-ED.
Hayward, D., Eikeseth, S., Gale, C., & Morgan, S. (2009). Assessing progress during treatment for young children with autism receiving
intensive behavioural interventions. Autism, 13(6), 613–633.
Heflin, L.J., & Alberto, P.A. (2001). Establishing a behavioral context for learning for students with autism. Focus on Autism and Other
Developmental Disabilities, 16(2), 93–101.
Hendricks, D.R. (2009). Overview of parent-implemented intervention. Chapel Hill: The University of North Carolina, Frank Porter Graham
Child Development Institute, The National Professional Development Center on Autism Spectrum Disorders.
Henning, B., & Sexton, A. (2016). Play activities. Master’s project, Department of Special Education, University of St. Thomas, Minneapolis,
MN.
Hepburn, S.L., & Stone, W.L. (2006). Longitudinal research on motor development in autism. In S.J. Rodgers & J.H.G. Williams (Eds.),
Imitation and the social mind: Autism and typical development (pp. 310–329). New York, NY: Guilford Press.
Herbert, M. (2012). The autism revolution: Whole body strategies for making life all it can be. New York, NY: Ballantine Books.
Hill, E.L. (2004). Evaluating the theory of executive dysfunction in Autism. Developmental Review, 24, 189–233.
Hilton, C., Graver, K., & LaVesser, P. (2007). Relationship between social competence and sensory processing in children with high
functioning autism spectrum disorders. Research in Autism Spectrum Disorders, 1(2), 164–173.
Hilton, C.L., Crouch, M.C., & Israel, H. (2008). Out-of-school participation patterns in children with high-functioning autism spectrum
disorders. American Journal of Occupational Therapy, 62, 554–563.
Hobson, J.A., Hobson, R.P., Cheung, Y., & Calo, S. (2015). Symbolizing as interpersonally grounded shifts in meaning: social play in children
with and without autism. Journal of Autism and Developmental Disorders, 45, 42.
Hobson, P.R. (2012). Autism, literal language and concrete thinking: Some developmental considerations. Metaphor & Symbol, 27(1), 4–21.
Hobson, P.R., Lee, A., & Hobson, J.A. (2009). Qualities of symbolic play among children with autism: A social-developmental perspective.
Journal of Autism and Developmental Disabilities, 39(1), 12–22.
Hochhauser, M., & Engel-Yeger, B. (2010). Sensory processing abilities and their relation to participation in leisure activities among children
with high-functioning autism spectrum disorder. Research in Autism Spectrum Disorders, 4, 746–754.
Howard, J.S., Sparkman, C.R., Cohen, H.G., Green, G., & Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic
treatment for young children with autism. Research in Developmental Disabilities, 26, 359–383.
Howlin, P., & Moss, P. (2012). Adults with autism spectrum disorders. Canadian Journal of Psychiatry, 57(5), 275–282.
Howlin, P., Savage, S., Moss, P., Tempier, A., & Rutter, M. (2014). Cognitive and language skills in adults with autism: A 40-year follow-up.
Journal of Child Psychiatry, 55(1), 49–58.
Hughes, C., Bernstein, R.T., Kaplan, L.M., Reilly, C.M., Brigham, N.L., Cosgriff, J.C., & Boykin, M.P. (2013). Increasing conversational
interactions between verbal high school students with autism and their peers without disabilities. Focus on Autism and Other Developmental
Disabilities, 28(4), 241–254.
Hume, K. (2013a). Antecedent-based intervention (ABI) fact sheet. Chapel Hill: The University of North Carolina, Frank Porter Graham Child
Development Institute, The National Professional Development Center on Autism Spectrum Disorders.
Hume, K. (2013b). Visual supports (VS) fact sheet. Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development
Institute, The National Professional Development Center on Autism Spectrum Disorders.
Hurwitz, S.C. (2002). To be successful: Let them play! Child Education, 79, 101–102.
Hutman, T., Chela, M.K., Gillespie-Lynch, K., & Sigman, M. (2012). Selective visual attention at twelve months: Signs of autism in early
social interactions. Journal of Autism and Developmental Disorders, 42(4), 487–498.
Hyman, S., & Levy, S. (2013). Autism spectrum disorders. In M. Batashaw, N. Roizen, & G. Lotrecchiano (Eds.), Children with disabilities
(7th ed., pp. 345–367). Baltimore, MD: Paul H. Brookes Publishing Co.
Ibañez, L.V., Messinger, D.S., Newell, L., Lambert, B., & Sheskin, M. (2008). Visual disengagement in the infant siblings of children with an
autism spectrum disorder (ASD). Autism, 12(5), 538–550.
Individuals with Disabilities Education Act (IDEA) of 1990, PL 101-476, 20 U.S.C. §§ 1400 et seq.
Individuals with Disabilities Education Act (IDEA) Amendments of 1997, PL 105-17, 20 U.S.C. §§ 1400 et seq.
Individuals with Disabilities Education Improvement Act. (2004a). Part B Regulations. Children and youth (ages 3–21). Retrieved from

326
 http://www2.ed.gov/policy/speced/reg/idea/part-b/index.html
Individuals with Disabilities Education Improvement Act. (2004b). Part C Regulations. Infants and toddlers (birth–age 2 and their families).
Retrieved from http://www2.ed.gov/policy/speced/reg/idea/part-c/index.html
Individuals with Disabilities Education Improvement Act (IDEA) of 2004, PL 108-446, 20 U.S.C. §§ 1400 et seq.
Ingersoll, B. (2008). The effect of context on imitation skills in children with autism. Research in Autism Spectrum Disorders, 2, 332–340.
Ingersoll, B. (2010). Brief report: Pilot randomized controlled trial of reciprocal imitation training for teaching elicited and spontaneous
imitation. Journal of Autism and Developmental Disorders, 40(9), 1154–1160.
Ingersoll, B. (2012). Brief report: Effect of a focused imitation intervention on social functioning in children with autism. Journal of Autism and
Developmental Disorders, 42(8), 1769–1773.
Ingersoll, B., & Lalonde, K. (2010). The impact of object and gesture imitation training on language use in children with autism spectrum
disorder. Journal of Speech, Language, and Hearing Research, 53(4), 1040.
Ingersoll, B., & Schreibman, L. (2006). Teaching reciprocal imitation skills to young children with autism using a naturalistic behavioral
approach: Effects on language, pretend play, and joint attention. Journal of Autism and Developmental Disorders, 36, 487.
Ingersoll, B., & Wainer, A. (2013). Pilot study of a school-based parent training program for preschoolers with ASD. Autism—International
Journal of Research and Practice, 17, 434–448.
Institute of Medicine. (2011). Adverse effects of vaccines: Evidence and causality. Washington, DC: National Academies Press.
Itzchak, E.B., & Zachor, D.A. (2011). Who benefits from early intervention in autism spectrum disorders? Research in Autism Spectrum
Disorders, 5(1), 345–350.
Jahr, E., Eldevik, S., & Eikeseth, S. (2000). Teaching children with autism to initiate and sustain cooperative play. Research in Developmental
Disabilities, 21(2), 151–169.
Jansiewicz, E.M., Goldberg, M.C., Newschaffer, C.J., Denckla, M.B., Landa, R., & Mostofsky, S.H. (2006). Motor signs distinguish children
with high functioning autism and Asperger’s syndrome from controls. Journal of Autism and Developmental Disorders, 36, 613.
Jarrold, C. (2003). A review of research into pretend play in autism. Autism, 7, 379–390.
Jarrold, C., Butler, D.W., Cottington, E.M., & Jimenez, F. (2000). Linking theory of mind and central coherence bias in autism and in the
general population. Developmental Psychology, 36(1), 126–138.
Jarrold, C., Gilchrist, I.D., & Bender, A. (2005). Embedded figures detection in autism and typical development: Preliminary evidence of a
double dissociation in relationships with visual search. Developmental Science, 8, 344–351.
Johnson, C.P., & Myers, S.M. (2007). American Academy of Pediatrics Council on Children with Disabilities. Identification and evaluation of
children with autism spectrum disorders. Pediatrics, 120(5), 1183–1215.
Jones, E.A., & Carr, E.G. (2004). Joint attention in children with autism: theory and intervention. Focus on Autism and Other Developmental
Disabilities, 19(1).
Jones, E.A., Carr, E.G., & Feeley, K.M. (2006). Multiple effects of joint attention intervention for children with autism. Behavior Modification,
30, 782–834.
Joseph, R.M., Tager-Flusberg, H., & Lord, C. (2002). Cognitive profiles and social-communicative functioning in children with autism
spectrum disorder. Journal of Child Psychology and Psychiatry, 43(6), 807–821.
Kaale, A., Fagerland, M.W., Martinsen, E.W., & Smith, L. (2014). Preschool-based social communication treatment for children with autism:
12-month follow-up of a randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry, 53, 188–198.
Kagan, J. (1994). Nature of the child. New York, NY: Basic Books.
Kamps, D., Royer, J., Dugan, E., Kravits, T., Gonzalez-Lopez, A., Garcia, J.,…& Kane, L.G. (2002). Peer training to facilitate social
interaction for elementary students with autism and their peers. Exceptional Children, 68, 173–187.
Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217–250.
Kasari, C., Freeman, S., & Paparella, T. (2006). Joint attention and symbolic play in young children with autism: A randomized controlled
intervention study. Journal of Child Psychology and Psychiatry, 47, 611–620.
Kasari, C., Gulsrud, A., Freeman, S., Paparella, T., & Hellemann, G. (2012). Longitudinal follow-up of children with autism receiving targeted
interventions on joint attention and play. Adolescent Psychiatry, 51(5), 487–495.
Kasari, C., Kaiser, A., Goods, K., Nietfeld, J., Mathy, P., Landa, R.,…& Almirall, D. (2014). Communication interventions for minimally
verbal children with autism: A sequential multiple assignment randomized trial. Journal of the American Academy of Child and Adolescent
Psychiatry, 53, 635–646.
Kashinath, S., Woods, J., & Goldstein, H. (2006). Enhancing generalized teaching strategy use in daily routines by parents of children with
autism. Journal of Speech, Language, and Hearing Research, 49, 466–485.
Kennedy, D.P., & Adolphs, R. (2014). Violations of personal space by individuals with autism spectrum disorder. PLoS One, 9(8), e103369.
Kenworthy, L., Yerys, B.E., Anthony, L.G., & Wallace, G.L. (2008). Understanding executive control in autism spectrum disorders in the lab
and in the real world. Neuropsychology Review, 18(4), 320–338.
Kim, S.H., & Lord, C. (2010). Restricted and repetitive behaviors in toddlers and preschoolers with autism spectrum disorders based on the
Autism Diagnostic Observation Schedule (ADOS). Autism Research, 3, 162–173.
Kleiman, L.J. (2003). Functional Communication Profile–Revised (FCP-R). Austin, TX: LinguiSystems.
Klin, A., Chawarska, K., Paul, R., Morgan, T., Wiesner, L., & Volkman, F. (2004). Autism in a 15-month-old child. American Journal of
Psychiatry, 161(11), 1981–1988.
Klin, A., & Jones, W. (2006). Attributing social and physical meaning to ambiguous visual displays in individuals with higher-functioning
autism spectrum disorders. Brain and Cognition: Special Issue: The Cognitive Neuroscience of Asperger Syndrome, 61(1), 40–53.
Koegel, L.K., Koegel, R.L., Frea, W.D., & Fredeen, R.M. (2001). Identifying early intervention targets for children with autism in inclusive
school settings. Behavior Modification, 25, 745–761.
Koegel, L.K., Koegel, R.L., Fredeen, R.M., & Gengoux, G.W. (2008). Naturalistic behavioral approaches to treatment. In K. Chawarska, A.
Klin, & F.R. Volkmar (Eds.), Autism spectrum disorders in infants and toddlers: Diagnosis, assessment, and treatment (pp. 207–242). New York,
NY: Guilford Press.
Koegel, R.L., & Koegel, L.K. (2006). Pivotal response treatments for autism: Communication, social & academic development. Baltimore, MD: Paul
H. Brookes Publishing Co.
Kover, S.T., Edmunds, S.R., & Weismer, S.E. (2016). Brief report: Ages of language milestones as predictors of developmental trajectories in
young children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 46(7), 2501–2507.
Krstovska-Guerrero, I., & Jones, E.A. (2016). Social-communication intervention for toddlers with autism spectrum disorder: Eye gaze in the
context of requesting and joint attention. Journal of Developmental and Physical Disabilities, 28(2), 289–316.
Kucharczyk, S. (2013a). Differential reinforcement of alternative, incompatible, or other behavior (DRA/I/O) fact sheet. Chapel Hill: The University
of North Carolina, Frank Porter Graham Child Development Institute, The National Professional Development Center on Autism Spectrum
Disorders.
Kucharczyk, S. (2013b). Reinforcement (R+) fact sheet. Chapel Hill: The University of North Carolina, Frank Porter Graham Child
Development Institute, The National Professional Development Center on Autism Spectrum Disorders.
Kuschner, E.S., Bennetto, L., & Yost, K. (2007). Patterns of nonverbal cognitive functioning in young children with autism spectrum disorders.

327
 Journal of Autism and Developmental Disorders, 37(5), 795–807.
Kuyper, L. (2011). Zones of Regulation: A curriculum designed to foster self-regulation and emotional control. Retrieved from
www.zonesofregulation.com
Lam, K.S.L., Bodfish, J.W., & Piven, J. (2008). Evidence for three subtypes of repetitive behavior in autism that differ in familiarity and
association with other symptoms. Journal of Child Psychology and Psychiatry, 49, 1193–1200.
Landa, R.J., & Goldberg, M.C. (2005). Language, social, and executive functions in high functioning autism: A continuum of performance.
Journal of Autism and Developmental Disorders, 35(5), 557.
Landa, R., & Kalb, L. (2012). Long-term outcomes of toddlers with autism spectrum disorders exposed to short-term intervention. Pediatrics,
130(Suppl. 2), S186–S190.
Landrigan, P.J., Lambertini, L., & Birnbaum, L.S. (2012). A research strategy to discover the environmental causes of autism and
neurodevelopmental disabilities. Environmental Health Perspectives, 120(7), A258–A260.
Lantz, J. (2001). Play time: An examination of play intervention strategies for children with autism spectrum disorders. The Reporter, 6(3), 1–7.
Retrieved from https://www.iidc.inidiana.edu
Laugeson, E.A., Ellingsen, R., Sanderson, J., Tucci, L., & Bates, S. (2014). The ABC’s of teaching social skills to adolescents with autism
spectrum disorder in the classroom: The UCLA PEERS[R] program. Journal of Autism and Developmental Disorders, 44(9), 2244.
LaVoie, R. (2005). Social skills autopsies: A strategy to promote and develop social competencies. Retrieved from
www.ldonline.com/article/Social_Skill_Autopsies
Leach, D., & LaRocque, M. (2011). Increasing social reciprocity in young children with autism. Intervention in School and Clinic, 46(3), 150–
156.
Leader, G., Loughnane, A., McMoreland, C., & Reed, P. (2009). The effect of stimulus salience on over-selectivity. Journal of Autism and
Developmental Disorders, 39, 330–338.
Lee, K., Lambert, H., Wittich, W., Kehavia, E., & Park, M. (2016). The use of movement-based interventions with children diagnosed with
autism for psychosocial outcomes—A scoping review. Research in Autism Spectrum Disorders, 24, 52–67.
Lee, L.C., Harrington, R.A., Louie, B.B., & Newschaffer, C.J. (2008). Children with autism: Quality of life and parental concerns. Journal of
Autism and Developmental Disorders, 38, 1147–1160.
Lee, S., Odom, S.L., & Loftin, R. (2007). Social engagement with peers and stereotypic behavior of children with autism. Journal of Positive
Behavior Intervention, 9, 67–79.
Leekam, S.R., Prior, M.R., & Uljarevic, M. (2011). Restricted and repetitive behaviors in autism spectrum disorders: A review of research in
the last decade. Psychological Bulletin, 137(4), 562.
Leon, Y., Lazarchick, W.N., Rooker, G.W., & DeLeon, I.G. (2013). Assessment of problem behavior evoked by disruption of ritualistic toy
arrangements in a child with autism. Journal of Applied Behavior Analysis, 46(2), 507–511.
Le Sourn-Bissaoui, S., Callies, S., Gierski, F., & Motte, J. (2011). Ambiguity detection in adolescents with Asperger syndrome: Is central
coherence or theory of mind impaired? Research in Autism Spectrum Disorders, 5(1), 648–656.
LeVesser, P., & Berg, C. (2011). Participation pattern in preschool children with autism spectrum disorder. OTJR: Occupation, Participation and
Health, 31, 33–39.
Lewis, M.H. (2004). Environmental complexity and central nervous system development and function. Mental Retardation and Developmental
Disabilities Research Reviews, 10, 91–95.
Leyfer, O.T., Folstein, S.E., Bacalman, S., Davis, N.O., Dinh, E., Morgan, J.,…& Lainhart, J.E. (2006). Comorbid psychiatric disorders in
children with autism: Interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36, 849–861.
Lifter, K., Ellis, J., Cannon, B., & Anderson, S.R. (2005). Developmental specificity in targeting and teaching play activities to children with
pervasive developmental disorders. Journal of Early Interventions, 27, 247–267.
Lincoln, A., Courchesne, E., Kilman, B., Elmasian, R., & Allen, M. (1988). A study of intellectual abilities in high-functioning people with
autism. Journal of Autism and Developmental Disorders, 18, 505–523.
Liss, M., Fein, D., Allen, D., Dunn, M., Feinstein, C., Morris, R.,…& Rapin, I. (2001). Executive functioning in high-functioning children
with autism. Journal of Child Psychology & Psychiatry & Allied Disciplines, 42, 261–270.
Little, L.M., Sideris, J., Ausderau, K., & Baranek, G.T. (2014). Activity participation among children with autism spectrum disorder. AJOT:
American Journal of Occupational Therapy, 68(2), 177.
Locke, J., Ishijima, E., Kasari, C., & London, N. (2010). Loneliness, friendship quality and the social networks of adolescents with high-
functioning autism in an inclusive school setting. Journal of Research in Special Educational Needs, 10, 74–81.
Lord, C. (2010). Autism: From research to practice. American Psychologist, 65(8), 815–886.
Lord, C., & Paul, R. (1997). Language and communication in autism. In D. Cohen & F. Volkmar (Eds.), Handbook of autism and pervasive
developmental disorders (2nd ed., pp. 195–225). New York, NY: Wiley.
Lord, C., Risi, S., & Pickles, A. (2004). Trajectory of language development in autistic spectrum disorders. In M.L. Rice & S.F. Warren (Eds.),
Developmental language disorders from phenotypes to etiologies (pp. 7–29). Mahwah, NJ: Lawrence Erlbaum Associates.
Lord, C., Rutter, M., DiLavore, P.C., Risi, S., Gotham, K., & Bishop, S. (2012). Autism Diagnostic Observation Schedule, Second Edition
(ADOS-2). Torrance, CA: Western Psychological Services.
Lovaas, O.I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting
and Clinical Psychology, 55, 3–9.
Lovaas, O.I., Freitag, G., Gold, V.J., & Kassorla, I.C. (1965). Experimental studies in childhood schizophrenia: Analysis of self-destructive
behavior. Journal of Experimental Child Psychology, 2, 67–84.
Loveland, K., & Tunali-Kotoski, B. (2005). The school-aged child with autism. In F. Volkmar, A. Klin, & R. Paul (Eds.), The handbook of
autism and pervasive developmental disorders (3rd ed., pp. 247–287). New York, NY: Wiley.
Luyster, R., Lopez, K., & Lord, C. (2007). Characterizing communicative development in children referred for autism spectrum disorders using
the MacArthur-Bates Communicative Development Inventory (CDI). Journal of Child Language, 34(3), 623–654.
Magiati, I., Tay, X.W., & Howlin, P. (2014). Cognitive, language, social and behavioural outcomes in adults with autism spectrum disorders: A
systematic review of longitudinal follow-up studies in adulthood. Clinical Psychology Review, 34(1), 73–86.
Maljaars, J., Noens, I., Jansen, R., Scholte, E., & van Berckelaer-Onnes, I. (2011). Intentional communication in nonverbal and verbal low-
functioning children with autism. Journal of Communication Disorders, 44(6), 601–614.
Mari, M., Castiello, U., Marks, D., Marraffa, C., & Prior, M. (2003). The reach-to-grasp movement in children with autism spectrum
disorder. Philosophical Transactions of the Royal Society of London Series B-Biological Sciences, 358, 393–403.
Mastrangelo, S. (2009). Harnessing the power of play. Opportunities for children with autism spectrum disorders. TEACHING Exceptional
Children, 42(1), 34–44.
Matson, J., & Dempsey, T. (2008). Stereotypy in adults with autism spectrum disorders: Relationship and diagnostic fidelity. Journal of
Developmental and Physical Disabilities, 20, 155.
Maurice, C., & O’Hanlon, M. (2010). Autism’s battle within. Washington, DC: The Brookings Institution. Retrieved from
https://www.brookings.edu/opinions/autisms-battle-within/
Mayer-Johnson LLC. (1981–2015). The Picture Communication Symbols. Pittsburg, PA: Tobii Dynavox.

328
Mayes, S. (2012). Checklist for Autism Spectrum Disorder (CASD). Chicago, IL: Stoelting.
Mazefsky, C.A., & Herrington, J.D. (2014). Autism and anxiety: Etiologic factors and transdiagnostic processes. In T.E. Davis III, S.W.
White, & T.H. Ollendick (Eds.), Autism and child psychopathology series: Handbook of autism and anxiety (pp. 91–104). New York, NY:
Springer.
Mazza, M., Pino, M.C., Mariano, M., Tempesta, D., Ferrara, M., De Berardis, D.,…& Valenti, M. (2014). Affective and cognitive empathy
in adolescents with autism spectrum disorder. Frontiers in Human Neuroscience, 8, 791.
McAfee, J., & Attwood, T. (2013). Navigating the social world: A curriculum for individuals with Asperger’s syndrome, high functioning autism and
related disorders. Arlington, TX: Future Horizons.
McBride, B.J., & Schwartz, I.S. (2003). Effects of teaching early interventionists to use discrete trials during ongoing classroom activities. Topics
in Early Childhood Special Education, 23(1), 5–17.
McClannahan, L.E., MacDuff, G.S., & Krantz, P.J. (2002). Behavior analysis and intervention for adults with autism. Behavior Modification,
26(1), 9–26.
McClelland, M., Cameron, C., Connor, C., Farris, C., Jewkes, A., & Morrison, F. (2007). Links between behavioral regulation and
preschoolers’ literacy, vocabulary, and math skills. Developmental Psychology, 43, 947–959.
McConnell, S.R. (2002). Interventions to facilitate social interaction for young children with autism: Review of available research and
recommendations for educational intervention and future research. Journal of Autism and Developmental Disorders, 32, 351–372.
McCormick, L., Loeb, D., & Schiefelbusch, R. (2003). Supporting children with communication difficulties in inclusive settings: School-based
language intervention (2nd ed.). Boston, MA: Pearson Education.
McGee, G.G., & Daly, T. (2007). Incidental teaching of age-appropriate social phrases to children with autism. Research and Practice for Persons
with Severe Disabilities, 32(2), 112–123.
McGee, G.G., Krantz, P.J., Mason, D., & McClannahan, L.E. (1983). A modified incidental-teaching procedure for autistic youth:
Acquisition and generalization of receptive object labels. Journal of Applied Behavior Analysis, 16(3), 329–338.
Meindl, J.N., & Cannella-Malone, H.I. (2011). Initiating and responding to joint attention bids in children with autism: A review of the
literature. Research in Developmental Disabilities, 32(5), 1441–1454.
Mesibov, G.B., & Shea, V. (2010). The TEACCH program in the era of evidence-based practice. Journal of Autism and Developmental
Disorders, 40(5), 570–579.
Mesibov, G., Shea, V., & Schopler, E. (2005). The TEACCH approach to autism spectrum disorders. New York, NY: Kluwer Academic.
Meyer, A., Rose, D.H., & Gordon, D. (2014). Universal design for learning: Theory and practice. Wakefield, MA: CAST Professional
Publishing. Retrieved from http://udltheorypractice.cast.org
Militerni, R., Bravaccio, C., Falco, C., Fico, C., & Palermo, M.T. (2002). Repetitive behaviors in autistic disorder. European Child and
Adolescent Psychiatry, 11(5), 210–218.
Miller, J. (2003). Women from another planet? Our lives in the universe of autism. Bloomington, IN: 1st Book Library.
Ming, X., Brimacombe, M., & Wagner, G.C. (2007). Prevalence of motor impairment in autism spectrum disorders. Brain & Development, 29,
565–570.
Minshew, N., & Goldstein, G. (2001). The pattern of intact and impaired memory functions in autism. Journal of Child Psychology and
Psychiatry, 42(3), 1095–1101.
Minshew, N.J., Scherf, K.S., Behrmann, M., & Humphreys, K. (2011). Autism as a developmental neurobiological disorder: New insights from
functional neuroimaging. In D.G. Amaral, G. Dawson, & D.H. Geschwind (Eds.), Autism spectrum disorders (pp. 632–650). New York, NY:
Oxford University Press.
Mitchell, P., & Ropar, D. (2004). Visuo-spatial abilities in autism: A review. Infant and Child Development, 13(3), 185–198.
Montgomery, C.B., Allison, C., Lai, M., Cassidy, S., Langdon, P.E., & Baron-Cohen, S. (2016). Do adults with high functioning autism or
asperger syndrome differ in empathy and emotion recognition? Journal of Autism and Developmental Disorders, 46, 1931.
Morrier, M.J., McGee, G.G., & Daly, T. (2009). Effects of toy selection and arrangement on the social behaviors of an inclusive group of
preschool-aged children. Early Childhood Services: An Interdisciplinary Journal of Effectiveness, 3, 157–177.
Mostert-Kerchkhoffs, M.A.L., Staal, W.G., Houben, R.H., & de Jonge, M.V. (2015). Stop and change: Inhibition and flexibility skills are
related to repetitive behaviour in children and young adults with autism spectrum disorders. Journal of Autism and Developmental Disorders,
45(10), 3148–3158.
Mundy, P., & Newell, L. (2007). Attention, joint attention and social cognition. Current Directions in Psychological Science, 16, 269–274.
Mundy, P., & Thorp, D. (2006). The neural basis of early joint attention behavior. In T. Charman & W. Stone (Eds.), Social and
communicative development in autism spectrum disorders (pp. 296–336). New York, NY: Guilford Press.
Murray, D.S., Creaghead, N.A., Manning-Courtney, P., Shear, P.K., Bean, J., & Prendeville, J. (2008). The relationship between joint
attention and language in children with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 23(1), 5–14.
Myles, B., Trautman, M.L., & Schelvan, R.L. (2004). The hidden curriculum: Practical strategies for understanding rules in social situations.
Shawnee Mission, KS: Autism Asperger Publishing.
Nadig, A.S., Ozonoff, S., Young, G.S., Rozga, A., Sigman, M., & Rodger, S.J. (2007). A prospective study of response-to-name in infants at
risk of autism. Archives of Pediatrics and Adolescent Medicine, 161, 378–383.
National Association for the Education of Young Children. (2012). References to play in NAEYC position statements. Retrieved from
www.naeyc.org
National Autism Center National Standards Project. (NSP, 2009; NSP2, 2015). Retrieved from http://www.nationalautismcenter.org/national-
standards-project/
National Professional Development Center on Autism Spectrum Disorders (NPDC-ASD). (n.d.). Retrieved from
http://autismpdc.fpg.unc.edu/
National Research Council. (2001). In C. Lord & J.P. McGee (Eds.), Educating children with autism. Committee on Educational Interventions
for Children with Autism. Division of Behavioral and Social Sciences and Education. Washington, DC: National Academies Press.
Neitzel, J. (2008). Overview of peer-mediated instruction and intervention for children and youth with autism spectrum disorders. Chapel Hill: The
University of North Carolina, Frank Porter Graham Child Development Institute, National Professional Development Center on Autism
Spectrum Disorders.
Neitzel, J. (2009a). Overview of antecedent-based interventions. Chapel Hill: The University of North Carolina, Frank Porter Graham Child
Development Institute, The National Professional Development Center on Autism Spectrum Disorders.
Neitzel, J. (2009b). Overview of reinforcement. Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development
Institute, The National Professional Development Center on Autism Spectrum Disorders.
Neitzel, J. (2009c). Overview of response interruption/redirection. Chapel Hill: The University of North Carolina, Frank Porter Graham Child
Development Institute, The National Professional Development Center on Autism Spectrum Disorders.
Neitzel, J. (2009d). Overview of time delay. Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development Institute,
The National Professional Development Center on Autism Spectrum Disorders.
Neitzel, J., & Wolery, M. (2009). Overview of prompting. Chapel Hill: The University of North Carolina, Frank Porter Graham Child
Development Institute, The National Professional Development Center on Autism Spectrum Disorders.

329
Nelson, L.J., Hart, C.H., & Evans, C.A. (2008). Solitary-functional play and solitary-pretend play: Another look at the construct of solitary-
active behavior using playground observations. Social Development, 17(4), 812–831.
Nuske, H.J., Vivanti, G., & Dissanayake, C. (2013). Are emotion impairments unique to, universal, or specific in autism? Cognition & Emotion,
27(6), 1042–1061.
Odom, S.L. (2013). Technology-aided instruction and intervention (TAII) fact sheet. Chapel Hill: The University of North Carolina, Frank Porter
Graham Child Development Institute, The National Professional Development Center on Autism Spectrum Disorders.
Odom, S.L., Collet-Klingenberg, Rodgers, S., & Hatton, D.D. (2010). Evidence based practices in interventions for children and youth with
autism spectrum disorders. Preventing School Failure, 5(4), 275–282.
Office of the High Commissioner for United Nations Human Rights. Convention on the Rights of the Child (1990). Article 31. Retrieved
from http://www.ohchr.org/en/professionalinterest/pages/crc.aspx
Oller, J.W., Oller, S.D., & Badon, L.C. (2012). Milestones: Normal speech and language development across the life span. San Diego, CA: Plural
Publishing.
Orr, E., & Geva, R. (2015). Symbolic play and language development. Infant Behavior and Development, 38, 147–161.
Orsmond, G.I., Krauss, M.W., & Seltzer, M.M. (2004). Peer relationships and social and recreational activities among adolescents and adults
with autism. Journal of Autism and Developmental Disorders, 34, 245–256.
Orsmond, G.I., & Kuo, H. (2011). The daily lives of adolescents with an autism spectrum disorder: Discretionary time use and activity
partners. Autism, 15, 1–21.
Osterling, J., Dawson, G., & Munson, J. (2002). Early recognition of 1-year-old infants with autism spectrum disorder versus mental
retardation. Developmental Psychopathology, 14, 239–251.
Owen-DeSchryver, J.S., Carr, E.G., Cale, S.I., & Blakeley-Smith, A. (2008). Promoting social interactions between students with autism
spectrum disorders and their peers in inclusive school settings. Focus on Autism and Other Developmental Disabilities, 23(1), 15–28.
Papacek, A.M., Chai, Z., & Green, K.B. (2016, September). Play and social interaction strategies for young children with autism spectrum
disorder in inclusive preschool settings. Young Exceptional Children, 19(3), 3–17.
Parten, M. (1932). Social participation among preschool children. Journal of Abnormal and Social Psychology, 27, 243–269.
Partington, J. (2006). Assessment of Basic Language and Learning Skills (ABLLS-R). Torrance, CA: Western Psychological Services.
Paul, R., Orlovski, S.M., Marcinko, H.C., & Volkmar, F. (2009). Conversational behaviors in youth with high-functioning ASD and Asperger
syndrome. Journal of Autism and Developmental Disorders, 39, 115–125.
Pellicano, E., Maybery, M., Durkin, K., & Maley, A. (2006). Multiple cognitive capabilities/deficits in children with an autism spectrum
disorder: “Weak” central coherence and its relationship to theory of mind and executive control. Development and Psychopathology, 18, 77–98.
Phelps-Terasaki, D., & Phelps-Gunn, T. (2007). Test of Pragmatic Language (TOPL-2). Austin, TX: LinguiSystems.
Piaget, J. (1962). Play, dreams, and imitation. New York, NY: W.W. Norton.
Pierce, K., Glad, K.S., & Schreibman, L. (1997). Social perception in children with autism: An attentional deficit? Journal of Autism and
Developmental Disorders, 27, 265–282.
Plavnick, J.B. (2013). Video modeling (VM) fact sheet. Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development
Institute, The National Professional Development Center on Autism Spectrum Disorders.
Ploog, B.O. (2010). Stimulus overselectivity four decades later: A review of the literature and its implications for current research in autism
spectrum disorder. Journal of Autism and Developmental Disorders, 40, 1332–1349.
Pollak, R. (1997). The creation of Dr. B: A biography of Bruno Bettelheim. New York, NY: Simon & Schuster.
Poon, K.K., Watson, L.R., Baranek, G.T., & Poe, M.D. (2012). To what extent do joint attention, imitation, and object play behaviors in
infancy predict later communication and intellectual functioning in ASD? Journal of Autism and Developmental Disorders, 42, 1064–1074.
Potter, C., & Whittaker, C. (2001). Enabling communication in children with autism. London, United Kingdom: Jessica Kingsley.
Prizant, B. (1996). Brief report: Communication, language, social and emotional development. Journal of Autism and Developmental Disorders,
26, 173–178.
Prizant, B.M., Wetherby, A.M., Rubin, E., & Laurent, A. (2003). The SCERTS Model: A transactional, family-centered approach to
enhancing communication and socioemotional abilities of children with autism spectrum disorder. Infants & Young Children, 16, 296–316.
Provost, B., Heimerl, S., & Lopez, B.R. (2007). Levels of gross and fine motor development in young children with autism spectrum disorder.
Physical & Occupational Therapy in Pediatrics, 27, 21–26.
Quill, K. (1995). Teaching children with autism: Strategies to enhance communication and socialization. Albany, NY: Delmar Publishers.
Quill, K. (1997). Instructional considerations for young children with autism: The rationale for visually-cued instruction. Journal of Autism and
Developmental Disabilities, 27, 697–714.
Quill, K. (1998). Environmental supports to enhance social-communication. Seminars in Speech and Language, 19, 407–423.
Quill, K. (2000). Do-Watch-Listen-Say: Social communication intervention for children with autism. Baltimore, MD: Paul H. Brookes Publishing
Co.
Quill, K. (2004, June). A complex disorder requires complex intervention. Keynote address delivered at the National Conference of the Autism
Society of Ontario, Toronto, Canada.
Quill, K. (2005). Language and Communication Characteristics. Autism internet modules www.autisminternetmodules.org
Quill, K., & Bracken, K. (1998). The dominance of non-verbal interactions among typically developing children: Rationale for rethinking social-
communication goals for children with autism. Unpublished manuscript.
Rapin, I. (2008). Etiologies of autism spectrum disorders. In P. Accardo (Ed.), Capute and Accardo’s neurodevelopmental disabilities in infancy and
childhood (3rd ed., Vol. 2, pp. 513–521). Baltimore, MD: Paul H. Brookes Publishing Co.
Ray-Subramanian, C.E., & Weismer, S.E. (2012). Receptive and expressive language as predictors of restricted and repetitive behaviors in
young children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(10), 2113–2120.
Reed, P., Altweck, L., Broomfield, L., Simpson, A., & McHugh, L. (2012). Effect of observing-response procedures on overselectivity in
individuals with autism. Focus on Autism and Other Developmental Disabilities, 27(4), 237–246.
Reed, P., Giles, A., Gavin, M., Carter, N., & Osborne, L.A. (2016). Loneliness and social anxiety mediate the relationship between autism
quotient and quality of life in university students. Journal of Developmental and Physical Disabilities, 28(5), 723–733.
Reeve, C., & Kabot, S. (2015). Taming the data monster. Shawnee Mission, KS: Autism Asperger Publishing.
Reynolds, S., Bendixen, R.M., Lawrence, T., & Lane, S.J. (2011). A pilot study examining activity participation, sensory responsiveness, and
competence in children with high functioning autism spectrum disorder. Journal of Autism and Developmental Disorders, 41, 1496–1506.
Riby, D.M., Doherty-Sneddon, G., & Whittle, L. (2012). Face-to-face interference in typical and atypical development. Developmental Science,
15, 281–291.
Richler, J., Heurta, M., Bishop, S.L., & Lord, C. (2010). Developmental trajectories of restricted and repetitive behaviors in children with
autism spectrum disorders. Development and Psychopathology, 22, 55–69.
Rimland, B. (1964). Infantile autism: The syndrome and its implications for a neural theory of behavior. New York, NY: Appleton-Century-Crofts.
Robins, D., Fein, D., & Barton, M. (2009). Modified Checklist for Autism in Toddlers–Revised (CHAT-R/FTM). Retrieved from https://m-
chat.org
Robinson, S., Goddard, L., Dritschel, B., Wisley, M., & Howlin, P. (2009). Executive functions in children with autism spectrum disorders.

330
 Brain and Cognition, 71, 362–368.
Rodger, S., & Umaibalan, V. (2011). The routines and rituals of families of typically developing children compared with families of children
with autism spectrum disorder: An exploratory study. British Journal of Occupational Therapy, 74, 20–26.
Rodriguez, N.M., Thompson, R.H., Schlichenmeyer, K., & Stocco, C.S. (2012). Functional analysis and treatment of arranging and ordering
by individuals with an autism spectrum disorder. Journal of Applied Behavior Analysis, 45, 1–22.
Rogers, S.J., Cook, I., & Meryl, A. (2005). Imitation and play in autism. In F.R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of
autism and pervasive disorders (3rd ed., Vol. 1, pp. 382–405). New York, NY: John Wiley & Sons.
Rogers, S.J., & Williams, J.H.G. (2006). Imitation in autism. In S.J. Rogers & J.H.G. Williams (Eds.), Imitation and the social mind: Autism and
typical development (pp. 277–310). New York, NY: Guilford Press.
Rogers, S.J., Young, G.S., Cook, I., Giolzetti, A., & Ozonoff, S. (2008). Deferred and immediate imitation in regressive and early onset autism.
Journal of Child Psychology and Psychiatry, 49(4), 449–457.
Rogers, S.J., Young, G.S., Cook, I., Giolzetti, A., & Ozonoff, S. (2010). Imitating actions on objects in early-onset and regressive autism:
Effects and implications of task characteristics on performance. Development and Psychopathology, 22(1), 71–85.
Rosenthal, M., Wallace, G.L., Lawson, R., Wills, M.C., Dixon, E., Yerys, B.E., & Kenworthy, L. (2013). Impairments in real-world executive
function increase from childhood to adolescence in autism spectrum disorders. Neuropsychology, 27(1), 13.
Rotheram-Fuller, E., Kasari, C., Chamberlain, B., & Locke, J. (2010). Grade related changes in the social inclusion of children with autism in
general education classrooms. Journal of Child Psychology and Psychiatry, 51(11), 1227–1234.
Rubin, K.H. (Ed.). (1980). Children’s play. San Francisco, CA: Jossey-Bass.
Rubin, K.H., Bukowski, W.M., & Laursen, B. (2009). Handbook of peer interactions, relationships, and groups. New York, NY: Guilford Press.
Ruble, L., McDuffie, A., King, A., & Lorenz, D. (2008). Caregiver responsiveness and social interaction behaviors of young children with
autism. Topics in Early Childhood Special Education, 28(3), 158–170.
Russ, S.W. (2014). Pretend play in childhood: Foundation of adult creativity. Washington, DC: American Psychological Association.
Russell, A.J., Jassi, A., Fullana, M.A., Mack, H., Johnston, K., Heyman, I., Murphy, D.G., & Mataix-Cols, D. (2013). Cognitive behavior
therapy for comorbid obsessive-compulsive disorder in high-functioning autism spectrum disorders: A randomized controlled trial. Depression
and Anxiety, 30, 697–708.
Rutherford, M.D., Young, G.S., Hepburn, S., & Rogers, S.J. (2007). A longitudinal study of pretend play in autism. Journal of Autism and
Developmental Disorders, 37(6), 1024–1039.
Rutter, M., Bailey, A., Lord, C., & Berument, S.K. (2003). The Social Communication Questionnaire (SCQ). Los Angeles, CA: Western
Psychological Services.
Rutter, M., LeCourteur, A., & Lord, C. (2008). Autism Diagnostic Interview–Revised (ADI-R). Los Angeles, CA: Western Psychological
Services.
Ruzzano, L., Borsboom, D., & Geurts, H.M. (2015). Repetitive behaviors in autism and obsessive–compulsive disorder: New perspectives from
a network analysis. Journal of Autism and Developmental Disorders, 45(1), 192–202.
Rydell, P., & Prizant, B. (1995). Education and communicative approaches for children who use echolalia. In K. Quill (Ed.), Teaching children
with autism: Methods to increase communication and socialization (pp. 105–132). Albany, NY: Delmar.
Sainsbury, C. (2000). Martian in the playground. London, United Kingdom: The Book Factory.
Sansosti, J.M., & Sansosti, F.J. (2012). Inclusion for students with high-functioning autism spectrum disorders: Definitions and decisions.
Psychology in Schools, 49(10), 917–931.
Sanz-Cervera, P., Pastor-Cerezuela, G., Fernandez-Andres, M.I., & Tarraga-Minguez, R. (2015). Sensory processing in children with autism
spectrum disorder: Relationship with non-verbal IQ, autism severity and attention deficit/hyperactivity disorder symptomatology. Research in
Developmental Disabilities, 45–46, 188–201.
Scattone, D., & Billhofer, B. (2007). Teaching sign language to a nonvocal child with autism. The Journal of Speech-Language Pathology and
Applied Behavior Analysis, 2(4), 78.
Schall, C., Wehman, P., & Carr, S. (2014). Transition from high school to adulthood for adolescents and young adults with autism spectrum
disorders. In F. Volkmar, B. Reichow, & J. Mcpartland (Eds.), Adolescents and adults with autism spectrum disorders (pp. 41–60). New York,
NY: Springer.
Schietecatte, I., Roevers, H., & Warreyn, P. (2012). Exploring the nature of joint attention impairments in young children with autism
spectrum disorder: Associated social and cognitive skills. Journal of Autism and Developmental Disorders, 42(1), 1–12.
Schopler, E., Van Bourgondien, M., Wellman, G.J., & Love, S. (2010). Childhood Autism Rating Scale (CARS-2). New York, NY: Pearson.
Schreibman, L., Dawson, G., Stahmer, A.C., Landa, R., Rogers, S., McGee, G.G.,…& Halladay, A. (2015). Naturalistic developmental
behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(8),
2411–2428.
Schreibman, L., & Koegel, R.L. (2005). Training for parents of children with autism: Pivotal responses, generalization, and individualization of
interventions. In E.D. Hibbs & P.S. Jensen (Eds.), Psychosocial treatment for child and adolescent disorders: Empirically based strategies for clinical
practice (2nd ed., pp. 605–631), Washington, DC: American Psychological Association.
Schulz, L.E., & Bonawitz, E.B. (2007). Serious fun: Engage in more exploratory play when evidence is confounded. Developmental Psychology,
43(4), 1043–1050.
Schurink, J., Hartman, E., Scherder, E.J.A., Houwen, S., & Visscher, C. (2011). Relationship between motor and executive functioning in
school-age children with pervasive developmental disorder not otherwise specified. Research in Autism Spectrum Disorders, 6(2), 726–732.
Sheinkopf, S., Muncy, P., Oller, D.K., & Steffens, M. (2000). Vocal atypicalities of preverbal autistic children. Journal of Autism and
Developmental Disorders, 30, 345–354.
Shield, A., & Meier, R.P. (2012). Palm reversal errors in native-signing children with autism. Journal of Communication Disorders, 45(6), 439–
454.
Shumway, S., & Wetherby, A.M. (2009). Communicative acts of children with autism spectrum disorders in the second year of life. Journal of
Speech, Language, and Hearing Research, 52, 1139–1156.
Siegel, B., Minshew, N., & Goldstein, G. (1996). Wechsler IQ profiles in diagnosis of high-functioning autism. Journal of Autism and
Developmental Disorders, 26, 389–406.
Siller, M., & Sigman, M. (2002). The behaviors of parents of children with autism predict the subsequent development of their children’s
communication. Journal of Autism and Developmental Disorders, 32(2), 77–89.
Simpson, R. (2005). Evidence-based practices and students with autism spectrum disorders. Focus on Autism and Other Developmental
Disabilities, 20(3), 140–149.
Smith, I.M., & Bryson, S.E. (2007). Gesture imitation in autism: II. Symbolic gestures and pantomimed object use. Cognitive Neuropsychology,
24(7), 679–700.
Smith, P., Hart, C.H., Sanson, A., Hemphill, S.A., Yagmurlu, B., & McClowry, S. (2010). Temperament and social development. In P.K.
Smith & C.H. Hart (Eds.), The Wiley-Blackwell handbook of childhood social development (2nd ed.). Oxford, United Kingdom: Wiley-
Blackwell.
Smith, T. (2001). Discrete trial training in the treatment of autism. Focus on Autism and Other Developmental Disabilities, 16(2), 86–92.

331
Snyder, T.D., & Dillow, S.A. (2012). Digest of education statistics 2011 (NCES 2012-001). Washington, DC: National Center for Education
Statistics, Institute of Education Sciences, U.S. Department of Education.
Solish, A., Perry, A., & Minnes, P. (2010). Participation of children with and without disabilities in social, recreational and leisure activities.
Journal of Applied Research in Intellectual Disabilities, 23, 226–236.
Solomon, M., Ozonoff, S.J., Cummings, N., & Carter, C.S. (2008). Cognitive control in autism spectrum disorders. International Journal of
Developmental Neuroscience, 26(2), 239–247.
South, M., Ozonoff, S., & McMahon, W.M. (2005). Repetitive behavior profiles in Asperger syndrome and high-functioning autism. Journal
of Autism and Developmental Disorders, 35(2), 145–158.
South, M., Ozonoff, S., & McMahon, W.M. (2007). The relationship between executive functioning, central coherence, and repetitive
behaviors in the high-functioning autism spectrum. Autism, 11, 437–451.
Sparrow, S., Cichetti, V., & Saulnier, C.A. (2016). Vineland Adaptive Behavior Scales, Third Edition (Vineland-3). New York, NY: Pearson.
Spiker, M., Lin, C.E., Van Dyke, M., & Wood, J.J. (2012). Restricted interests and anxiety in children with autism. Autism, 16(3), 306–320.
Stanley, G.C., & Konstantareas, M.M. (2007). Symbolic play in children with autism spectrum disorder. Journal of Autism and Developmental
Disorders, 37(7), 1215–1223.
Stiegler, L.N. (2015). Examining the echolalia literature: Where do speech-language pathologists stand? American Journal of Speech-Language
Pathology, 24(4), 750–762.
Stone, W., Ruble, Coonrod, E., Hepburn, S., Pennington, M., Burnette, C., & Brigham, N.B. (2010). TRIAD Social Skills Assessment.
Nashville, TN: Treatment and Research Institute for Autism Spectrum Disorders.
Stoner, R., Chow, M.L., Boyle, M.P., Sunkin, S.M., Mouton, P.R., Roy, S.,…& Courchesne, E. (2014). Patches of disorganization in the
neocortex of children with autism. New England Journal of Medicine, 370, 1209–1219.
Stoppelbein, L., Biasini, F., Pennick, M., & Greening, L. (2016). Predicting internalizing and externalizing symptoms among children
diagnosed with an autism spectrum disorder: The role of routines. Journal of Child and Family Studies, 25(1), 251–261.
Sundberg, M. (2008). The Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP). Concord, CA: AVB Press.
Svetlova, M., Nichols, S.R., & Brownell, C.A. (2010). Toddlers’ prosocial behavior: From instrumental to empathic to altruistic helping. Child
Development, 81(6), 1814–1827.
Sytsma, S.E., Kelley, M.L., & Wymer, J.H. (2001). Development and initial validation of the child routines inventory. Journal of
Psychopathology and Behavioral Assessment, 23, 241–251.
Szatmari, P., Georgiades, S., Bryson, S., Zwaigenbaum, L., Roberts, W., Mahoney, W.,…& Tuff, L. (2006). Investigating the structure of the
restricted, repetitive behaviours and interests domain of autism. Journal of Child Psychology and Psychiatry, 47, 582–590.
Szidon, K., & Franzone, E. (2009). Task analysis. Madison: University of Wisconsin, Waisman Center, The National Professional
Development Center on Autism Spectrum Disorders.
Tager-Flusberg, H. (1996). Brief report: Current theory and research on language and communication in autism. Journal of Autism and
Developmental Disorders, 26, 169–178.
Tager-Flusberg, H. (2007). Evaluating the theory-of-mind hypothesis of autism. Current Directions in Psychological Science, 16, 311–315.
Tager-Flusberg, H. (2016). Risk factors associated with language in autism spectrum disorder: Clues to underlying mechanism. Journal of Speech
Language and Hearing Research, 59(1), 143–154.
Tager-Flusberg, H., & Joseph, R.M. (2005a). How language facilitates the acquisition of false-belief understanding in children with autism. In
J.W. Astington & J.A. Baird (Eds.), Why language matters for theory of mind (pp. 298–318). Oxford, United Kingdom: Oxford University
Press.
Tager-Flusberg, H., & Joseph, R.M. (2005b). Theory of mind, language, and executive functions in autism: A longitudinal perspective. In W.
Schneider, R. Schumann-Hengsteler, & B. Sodian (Eds.), Young children’s cognitive development: Interrelationships among executive functioning,
working memory, verbal ability, and theory of mind (pp. 239–257). London, United Kingdom: Taylor & Francis.
Tager-Flusberg, H., Paul, R., & Lord, C. (2005). Language and communication in autism. In F.R. Volkmar, R. Paul, A. Klin, & D. Cohen
(Eds.), Handbook of autism and pervasive developmental disorders (3rd ed., Vol. 1, pp. 335–364). Hoboken, NJ: John Wiley & Sons.
Tager-Flusberg, H., Rogers, S., Cooper, J., Landa, R., Lord, C., & Paul, R. (2009a). Defining spoken language benchmarks and selecting
measures of expressive language development for young children with autism spectrum disorders. Journal of Speech, Language, and Hearing
Research, 52(3), 643.
Tager-Flusberg, H., Rogers, S., Cooper, J., Landa, R., Lord, C., Paul, R.,…& Yoder, P. (2009b). Defining spoken language benchmarks and
selecting measures of expressive language development for young children with autism. Journal of Speech, Language, and Hearing Research,
52(3), 643–652.
Tanner, K., Hand, B.N., O’Toole, G., & Lane, A.E. (2015). Effectiveness of interventions to improve social participation, play, leisure, and
restricted and repetitive behaviors in people with autism spectrum disorder: a systematic review. AJOT: American Journal of Occupational
Therapy, 69(5), 1–12.
Taylor, L.E., Swerdfeger, A.L., & Eslick, G.D. (2014). Vaccines are not associated with autism: An evidence-based meta-analysis of case-
control and cohort studies. Vaccine, 32(29), 3623–3629.
Thiermann-Bourque, K.S., Brady, N.C., & Fleming, K.K. (2012). Symbolic play of preschoolers with severe communication impairments with
autism and other developmental delays: More similarities than differences. Journal of Autism and Developmental Disorders, 42(5), 863–873.
Tick, B., Bolton, P., Happé, F., Rutter, M., & Rijsdijk, F. (2016). Heritability of autism spectrum disorders: A meta-analysis of twin studies.
Journal of Child Psychology and Psychiatry, 57(5), 585–595.
Tomasello, M., & Carpenter, M. (2007). Shared intentionality. Developmental Science, 10(1), 121–125.
Tomasello, M., Carpenter, M., Call, J., Behne, T., & Moll, H. (2005). Understanding and sharing intentions: The origins of cultural cognition.
Behaviour and Brain Sciences, 28, 675–735.
Toth, K., Munson, J., Meltzoff, A., & Dawson, G. (2006). Early predictors of communication development in young children with autism
spectrum disorder: Joint attention, imitation, and toy play. Journal of Autism and Developmental Disorders, 36(8), 993–1005.
Tracy, J.L., Robins, R.W., Schriber, R.A., & Solomon, M. (2011). Is emotion recognition impaired in individuals with autism spectrum
disorders? Journal of Autism and Developmental Disorders, 41(1), 102–109.
Travis, L.L., & Sigman, M. (2001). Communicative intentions and symbols in autism: Examining a case of altered development. In J.A.
Burack, T. Charman, N. Yirmiya, & P.R. Zelazo (Eds.), The development of autism. Perspectives from theory and research (pp. 279–308).
Mahwah, NJ: Lawrence Erlbaum Associates.
Trembath D., Balandin S., & Rossi C. (2005). Crosscultural practice and autism. Journal of Intellectual and Developmental Disability, 30, 240–
242.
Troyb, E., Knock, K., Herlihy, L., Stevens, M.C., Chi-Ming, C., Barton, M.,…& Fein, D. (2016). Restricted and repetitive behaviors as
predictors of outcome in autism spectrum disorders. Journal of Autism and Developmental Disorders, 46(4), 1282–1296.
Tsao, L. (2002). How much do we know about the importance of play in child development? Child Education, 78, 230–233.
Tsatsanis, K.D. (2003). Outcome research in Asperger syndrome and autism. Child and Adolescent Psychiatric Clinics of North America, 12, 45–63.
Tuchman, R., Hirtz, D., & Mamounas, L.A. (2013). NINDS epilepsy and autism spectrum disorders workshop report. Neurology, 81(18),
1630–1636.

332
U.S. Department of Education. (2010). Thirty-five years of progress in educating children with disabilities through IDEA. Retrieved from
http://www2.ed.gov/about/offices/list/osers/idea35/history/idea-35-history.pdf
U.S. Department of Education, Institute of Education Sciences. What Works Clearinghouse. Retrieved from http://ies.ed.gov/ncee/wwc/
van Berckelaer-Onnes, I.A. (2003). Promoting early play. Autism: The International Journal of Research and Practice, 7, 415–423.
van der Aalsvoort, G.M., & van der Leeden, R. (2009). The microgenetic emergence of cooperative play in 6-year-olds developmentally at-risk.
International Journal of Educational Research, 48(4), 274–285.
Van Heijst, B.F., & Geurts, H.M. (2014). Quality of life in autism across the lifespan: A meta-analysis. Autism, 19(2), 158–167.
van Ommeren, T.B., Begeer, S., Scheeren, A.M., & Koot, H.M. (2012). Measuring reciprocity in high functioning children and adolescents
with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(6), 1001–1010.
Vanvuchelen, M., Roeyers, H., & DeWeerdt, W. (2007). Nature of motor imitation problems in school-aged boys with autism: A motor or a
cognitive problem? Autism, 11(3), 225–240.
Vermeulen, P. (2012). Autism as context blindness. Shawnee Mission, KS: Autism Asperger Publishing.
Vermeulen, P. (2015). Context blindness in autism spectrum disorders: Not using the forest to see the trees as trees. Focus on Autism and Other
Developmental Disabilities, 30(3), 182–192.
Vernon, T.W., Koegel, R.L., Dauterman, H., & Stolen, K. (2012). An early social engagement intervention for young children with autism and
their parents. Journal of Autism and Developmental Disorders, 42(12), 2702–2717.
Vicker, B. (2009). Meeting the challenge of social pragmatics with students on the autism spectrum. The Reporter, 14(2), 11–17.
Vivanti, G., Nadig, A., Ozonoff, S., & Rogers, S.J. (2008). What do children with autism attend to during imitation tasks? Journal of
Experimental Child Psychology, 101(3), 186–205.
Vivanti, G., Trembath, D., & Dissanayake, C. (2014). Mechanisms of imitation impairment in autism spectrum disorder. Journal of Abnormal
Child Psychology, 42(8), 1395–1405.
Volkmar, F.R., Paul, R., Klin, A., & Cohen, D. (2005). Handbook of autism and pervasive development disorders. Volume 2: Assessment,
interventions, and policy (3rd ed.). Hoboken, NJ: John Wiley & Sons.
Vygotsky, L.S. (1964). Thought and language. New York, NY: John Wiley & Sons.
Warren, S.F., Bredin-Oja, S.L., Escalente, M.F., Finestack, L.H., Fey, M.E., & Brady, N.C. (2006). Responsivity education/prelinguistic
milieu teaching. In R. McCauley & M. Fey (Eds.), Treatment of language disorders in children (pp. 47–75). Baltimore, MD: Paul H. Brookes
Publishing Co.
Watkins, L., O’Reilly, M., Kuhn, M., Gevarter, C., Lancioni, G.E., & Sigafoos, J. (2015). A review of peer-mediated social interaction
interventions for students with autism in inclusive settings. Journal of Autism and Developmental Disorders, 45(4), 1070.
Watt, N., Wetherby, A., & Shumway, S. (2006). Prelinguistic predictors of language outcome at 3 years of age. Journal of Speech, Language, and
Hearing Research, 49, 1224–1237.
Weismer, S.E., & Kover, S.T. (2015). Preschool language variation, growth, and predictors in children on the autism spectrum. Journal of Child
Psychology and Psychiatry, 56(12), 1327–1337.
Wells, G. (1981). Learning through interaction: The study of language development. Cambridge, United Kingdom: Cambridge University Press.
Werner, E., & Dawson, G. (2005). Validation of the phenomenon of autistic regression using home videotapes. Archives of General Psychiatry,
62(8), 889–895.
Westby, C.E. (2000). A scale for assessing development of children’s play. In K. Gitlin-Weiner, A. Sandgrund, & C. Schaefer (Eds.), Play
diagnosis and assessment (pp. 15–57). New York, NY: Wiley.
Wetherby, A. (1986). Ontogeny of communicative functions in autism. Journal of Autism and Developmental Disorders, 16, 295–316.
Wetherby, A. (2006). Understanding and measuring social communication in children with autism spectrum disorders. In T. Charman & W.
Stone (Eds.), Social and communication development in autism spectrum disorders: Early identification, diagnosis, and intervention (pp. 3–34). New
York, NY: Guilford Press.
Wetherby, A., Guthrie, W., Woods, J., Schatschneider, R.D., Holland, R.D., Morgan, L., & Lord, C. (2014). Parent implemented social
intervention for toddlers with autism: An RCT. Pediatrics, 134(6), 1084–1093.
Wetherby, A.M., & Prizant, B.M. (1993; 2002). Communication and Symbolic Behavior Scales Developmental Profile. Baltimore, MD: Paul H.
Brookes Publishing Co.
Wetherby, A.M., Prizant, B.M., & Schuler, A.L. (2000). Understanding the nature of communication and language impairments. In S.F.
Warren & J. Reichle (Series Eds.) & A.M. Wetherby & B.M. Prizant (Vol. Eds.), Communication and language intervention series: Volume 9.
Autism spectrum disorders: A transactional perspective (pp. 109–141). Baltimore, MD: Paul H. Brookes Publishing Co.
Wetherby, A.M., Watt, N., Morgan, L., & Shumway, S. (2007). Social communication profiles of children with autism spectrum disorders late
in the second year of life. Journal of Autism and Developmental Disorders, 37, 960–975.
Whalen, C., Schreibman, L., & Ingersoll, B. (2006). The collateral effects of joint attention training on social initiations, positive affect,
imitation, and spontaneous speech for young children with autism. Journal of Autism and Developmental Disorders, 36(6), 655–664.
White, S.W., Keonig, K., & Scahill, L. (2007). Social skills development in children with autism spectrum disorders: A review of the
intervention research. Journal of Autism and Developmental Disorders, 37(10), 1858–1868.
White, S.W., O’Reilly, & Frith, J. (2009). Big heads, small details and autism. Neuropsychologia, 47(5), 1274–1281.
White, S.W., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical
Psychology Review, 29, 216–229.
Wiig, E.H., Semel, E., & Secord, W.A. (2013). Clinical Evaluation of Language Fundamentals, Fifth Edition (CELF-5). Pragmatic Profile and
Pragmatic Activities Checklist. New York, NY: Pearson.
Williams, D., & Happé, F. (2010). Recognising ‘social’ and ‘non-social’ emotions in self and others: A study of autism. Autism, 14, 285–304.
Williams, D.M. (2010). Theory of own mind in autism: Evidence for a specific deficit in self-awareness. Autism, 14(5), 474–494.
Williams, D.M., & Happé, F. (2009). What did I say? versus What did I think? Attributing false beliefs to self amongst children with and
without autism. Journal of Autism and Developmental Disorders, 39, 865–873.
Williams, E. (2003). A comparative review of early forms of object-directed play and parent-infant play in typical infants and young children
with autism. Autism, 7(4), 361–374.
Williams, E., Reddy, V., & Costall, A. (2001). Taking a closer look at functional play in children with autism. Journal of Autism and
Developmental Disorders, 31, 67–77.
Williams, J., Whiten, A., & Singh, T. (2004). A systematic review of action imitation in autism spectrum disorder. Journal of Autism and
Developmental Disorders, 34, 285–299.
Wolfberg, P. (1999; 2009). Play and imagination in children with autism (2nd ed.). New York, NY: Teachers College Press.
Wolfberg, P.J. (2015). Play’s role and meaning in the lives of children with autism. In D. Fromberg & D. Bergin (Eds.), Play from birth to
twelve: Contexts, perspectives, and meanings (3rd ed.). New York, NY: Routledge.
Wolfberg, P., & Schuler, A. (2006). Promoting social reciprocity and symbolic representation in children with ASD: Designing quality peer
play interventions. In T. Charman & W. Stone (Eds.), Social and communication development in autism spectrum disorders: Early identification,
diagnosis, and intervention (pp. 180–218). New York, NY: Guilford Press.
Wolfberg, P.J., McCracken, H.M., & Tuchel, T. (2008). Fostering peer play and friendships: Creating a culture of inclusion. In K. Dunn

333
 Buron & P.J. Wolfberg (Eds.), Learners on the autism spectrum: Preparing highly qualified educators (pp. 183–207). Shawnee Mission, KS:
Autism Asperger Publishing.
Wong, C. (2013a). Picture Exchange Communication System (PECS) fact sheet. Chapel Hill: The University of North Carolina, Frank Porter
Graham Child Development Institute, The National Professional Development Center on Autism Spectrum Disorders.
Wong, C. (2013b). Social narratives (SN) fact sheet. Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development
Institute, The National Professional Development Center on Autism Spectrum Disorders.
Wong, C., Odom, S.L., Hume, K., Cox, A.W., Fettig, A., Kucharczyk, S.,…& Schultz, T.R. (2014). Evidence-based practices for children, youth,
and young adults with autism spectrum disorder. Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development
Institute, The Autism Evidence-Based Practice Review Group.
Wong, C., Odom, S.L., Hume, K.A., Cox, A.W., Fettig, A., Kucharczyk, S.,…& Schultz, T.R. (2015). Evidence-based practices for children,
youth, and young adults with autism spectrum disorder: A comprehensive review. Journal of Autism and Developmental Disorders, 45(7), 1951–
1966.
World Health Organization. (2016). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines.
Geneva, Switzerland: Author.
Yanerys, L., Lazarchick, W.N., Rooker, G.W., & DeLeon, I.G. (2013). Assessment of problem behavior evoked by disruption of ritualistic toy
arrangements in a child with autism. Journal of Applied Behavior Analysis, 46(2), 507–511.
Yerys, B.E., Wallace, G.L., Harrison, B., Celano, M.J., Giedd, J.N., & Kenworthy, L.E. (2009). Set-shifting in children with autism spectrum
disorders: Reversal shifting deficits on the Intradimensional/Extradimensional Shift Test correlate with repetitive behavior. Autism, 13, 523–
539.
Yoder, P., Watson, L., & Lambert, W. (2015). Value-added predictors of expressive and receptive language growth in initially. Journal of Autism
and Developmental Disorders, 45(5), 1254–1270.
Yoder, P.J. (2008). Initiating joint-attention treatment facilitates later expressive language development, particularly in initially low-verbal
children with autism. Evidence-Based Communication Assessment and Intervention, 2(2), 99–102.
Yoder, P.J., & McDuffie, A.S. (2006). Treatment of responding and initiating joint attention. In T. Charman & W. Stone (Eds.), Social and
communication development in autism spectrum disorders: Early identification, diagnosis, and intervention (pp. 117–142). New York, NY: Guilford
Press.
Yoder, P.J., & Warren, S.F. (2001). Intentional communication elicits language-facilitating maternal responses in dyads with children who have
developmental disabilities. American Journal on Mental Retardation, 106, 327–335.
Young, G.S., Rogers, S.J., Hutman, T., Rozga, A., Sigman, M., & Ozonoff, S. (2011). Imitation from 12 to 24 months in autism and typical
development: A longitudinal rasch analysis. Developmental Psychology, 47(6), 1565–1578.
Zabala, J. (2005). Using the SETT framework to level the learning field for students with disabilities. Retrieved from www.joyzabala.com
Zandt, F., Prior, M., & Kyrios, M. (2007). Repetitive behaviour in children with high functioning autism and obsessive compulsive disorder.
Journal of Autism and Developmental Disorders, 37(2), 251–259.

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Index

References to tables and figures are indicated with a t and f, respectively

AAC, see Augmentative and alternative communication

AAP, see American Academy of Pediatrics
ABA, see Applied behavior analysis
Activities to promote skill development, 273–321
closed-ended activities, 216–217
compensatory supports, 275t
meaningful activities, 218–219
motivating activities, 217–218
open-ended activities, 216–217
Activity routines, organization of, 249–250
Activity schedules, 254
Adaptive Behavior Assessment System, 69t
Adaptive behavior scales, 67, 69t
Affective cues, in conversation, 56
AFIRM, see Autism Focused Intervention Resources and Modules
AIM, see Autism Internet Modules
American Academy of Pediatrics (AAP), 25
American Speech-Language-Hearing Association (ASHA), 25
Anxiety, 45, 190
Applied behavior analysis (ABA), 4, 194
ASCS-2, see Assessment of Social and Communication Skills for Individuals with Autism Spectrum Disorder, Revised
ASD, see Autism spectrum disorder
Assessment of social and communication skills
adaptive behavior scales, 67, 69t
communication assessments, 67, 69, 71t
curriculum-based assessments, 69, 72t
educational assessments, 66
pragmatic skills assessments, 69, 72t
screening and diagnostic instruments, 67, 68t
social assessments, 67, 70t
videotaped analysis for, 78, 79, 327
Assessment of Social and Communication Skills for Individuals with Autism Spectrum Disorder, Revised (ASCS-2), 65, 101–139
administration and data collection guidelines
direct sampling of skills, 78–79, 116
interviews, 77, 102, 108, 116
observations, 78, 102, 108, 116
structured communication opportunities, 79
structured social opportunities, 79
advantages and limitations, 94, 96, 99
Behavior Profile, 71, 75, 79–80, 80t, 81f, 102–107
case study, 79–94
Obstacles Questionnaire, 71, 75, 80–84, 82t, 83f, 84f, 85f, 86f, 108–115
program planning, 93–94
form, 96f, 97f, 98f, 137–139
purpose of, 102, 108, 115
rationale
core skills importance, 73–74
executive functioning and social cognition importance, 74
generalization importance, 74
Skills Checklist, 71–72, 76–77, 84, 86, 87t, 88f, 89f
assessment, 118–129
data summarization, 90–93, 91f, 92f, 93f
overview, 116–117
program planning form, 96f, 97f, 98f, 137–139
progress monitoring display, 131–136
see also Progress monitoring
Assistive technology (AT), 178
Association for Science in Autism Treatment (ASAT), 196
Attention, 9t
difficulty in shifting, 13–14, 41

335
 executive dysfunction, 10
joint, 10, 26–27, 30–31, 41, 49, 233, 279
overselective, 11–12
ritualistic behaviors, 5
shared, 215
social, 5, 10–11
Audio and video recording, as qualitative data collection method, 78, 79, 327
Auditory sensitivity, 12
Augmentative and alternative communication (AAC) supports, 234
aided supports, 178
comparison of systems, 178
features of, 179t
selection of, 178, 179, 180t
Student, Environments, Tasks, Tools (SETT) framework, 179
types of, 259, 260t, 266
conversation books, 264
cue cards, 263
interactive communication boards, 262–263
Picture Exchange Communication System (PECS), 180, 260–261
sign language, 261–262
speech-generating device (SGD), 178, 264–265
voice output communication aids (VOCA), 178, 264–265
unaided supports, 178
Autism Focused Intervention Resources and Modules (AFIRM), 197
Autism Internet Modules (AIM), 196
Autism spectrum disorder (ASD)
complexity of, 1–22
contemporary implications of
prevalence, 4–5
prognosis, 5
historical overview of
educational history, 4
medical history, 2–4
identification and diagnosis of
coexisting conditions, 7–8
early identification, 7
educational eligibility, 8–9
medical diagnosis, 5–6, 5f
nature of, 2–4
nonverbal social-communication, 6, 27–31, 28t
seizures, 3, 7

Behavior Profile, in Assessment of Social and Communication Skills for Individuals with Autism Spectrum Disorder, Revised (ASCS-2), 71, 75, 79–80,
80t, 81f, 102–107
Behavior Rating Inventory of Executive Function (BRIEF), 69t
Behavioral interventions, 197
applied behavior analysis (ABA), 194, 201–202
discrete trial training (DTT), 194, 201
Behavioral regulation, 26, 29
Behavioral supports, 272
for behavior challenges, 266–267
repetitive strategies of, 270–271
Behaviors
consequences for, 223
problem, intervention setting and, 214
see also Repetitive behaviors intervention; Ritualistic behaviors
Body language, in conversation, 46, 46t

Catatonia, 8
CEC, see Council for Exceptional Children
Center for Applied Special Technology (CAST), 210
Centers for Disease Control and Prevention (CDC), 25
Challenging behaviors, 266–267
Choosing Outcomes and Accommodations for Children (COACH), 144
Choral activity, 173, 174t
Closed-ended activities, 216–217
Coaching peers, 235–237
Coexisting conditions, with autism spectrum disorder (ASD), 7–8
Cognition in autism, 174–175
social cognition, 9t, 10–11
empathizing and systemizing, 20
impaired, 190–191
misunderstanding, 20–22, 21f
theory of mind (ToM) blindness, 19–20, 21f
see also Attention; Information processing
Commenting skills, 310–311
Communication assessments, 67, 69, 71t

336
Communication boards, 262–263
Communication initiation, interventions for expansion of, 184, 304–312
Communication skills
activity sheets, 304–321
for basic responses increase, 306–307
for commenting increase, 310–311
for question answering increase, 308–309
for question asking increase, 312
for request making increase, 304–305
assessment of, 179
augmentative and alternative communication (AAC) supports, 178–179, 179t, 180t, 234, 259–266, 260t
communication definition, 48
components of, 51f
core skills for, 23–33, 24f
data questions, 325–326, 325t
development, 25–26
deficits in autism, 49–50, 56–57
milestones for, 46t
typical, 48–49, 53–56
in DO-WATCH-LISTEN-SAY framework, 62
echolalia and, 6, 52–53
functional interventions for expansion of, 180–183
intervention planning for, 144
key features of communication, 176t
language skills compared to, 50–51
prelinguistic stage, 25
reciprocal communication, 39, 49
ritualistic behaviors and, 58, 59t
see also Assessment of social and communication skills
Communication skills intervention
assistive technology (AT), 178
basic communicative roles, 176, 183
initiations expansion, 184, 304–312
meaningful responses expansion, 184
communicative functions
functional communication expansion, 180–183, 182f
functions expansion, 182
mirroring same-age peers, 145, 149, 149f, 182
multiple settings target, 182–183
social partners consideration, 182
interactive role, 176
means of communication, 175, 177t
selection of, 177–178
motivation to communicate, 175
interventions for increasing, 176–177
social functions, 19, 175
Communication supports, see Augmentative and alternative communication (AAC) supports
Communicative functions, 175, 224
functional communication expansion, 180–183, 182f
functions expansion, 182
mirroring same-age peers, 145, 149, 149f, 182
multiple settings target, 182–183
social partners consideration, 182
Augmentative and alternative communication (AAC) supports—continued
Communicative intent, 224–226
Communicative means, 175, 177t
selection of, 177–178
Communicative motivation, 175
interventions for increasing, 176–177
Community planning guide forms, 352, 356–363, 387–390
Community skills
assessment, 186–187
intervention planning framework, 187t
participation organization, 247t, 249
support plan, 188
targeting skills, 187–188
Complexity, of autism spectrum disorder (ASD), 1–22
Computer software, educational, 265
Concrete thinking, 16–17
Conduct disorder, autism spectrum disorder (ASD) coexisting with, 7
Consequences for behavior, 223
Context blindness, 14–15
Conversation
activity sheets use
for nonverbal conversation increase, 320–321
for verbal reciprocity increase, 316–317
for verbal topics increase, 318–319

337
 adult–child compared to peer–peer, 54
basic requirements for, 55
deficits in autism, 56–58
elements
affect, 56
body language, 45
perspective taking, 55–56
proximity, 56
topic maintenance, 55
turn taking, 55, 173, 174t
skills development for, 54, 57–58
teaching basic skills, 184–186
theory of mind (ToM) tasks for, 57
typical development, 54–56
verbal, 57, 316–319
Conversation books, 264
Conversation transcript forms, 350, 383
Cooperative play, 38, 38f, 39, 40
Core skills, 24f, 73–74
early developmental milestones, 24–25, 24t
imitation, 31–33
nonverbal social–communicative interaction, 27–31
progress forms, 339, 342
for social skills, 25, 159, 160f
solitary play influenced by, 163–166, 164t–165t
Core skills activity sheets, 279–288
Core skills intervention, 159, 162
imitation
building skills, 154
what skills to teach, 154–155
intervention designs to teach, 150–151, 152f
structured learning opportunities, 152
systematic instruction, 152
systematically scaffold skills, 152–153
nonverbal social–communicative interaction
building skills, 154
what skills to teach, 153
Council for Exceptional Children (CEC), 195
Interdivisional Research Group, 196
Creative play, 34
imaginative, 36
object substitution, 35
role taking, 35
with objects, 35, 36, 42
with self, 35
symbolic, 35–36
Cue cards, 263
Cues
environmental
contrived, 220
natural, 220
making nonverbal cues more explicit, 234, 274
relaxation, 258
social, 20, 45–46
contrived, 220
natural, 220
visually cued instruction, 222, 251–259, 251t
Curriculum-based assessments, 69, 72t

Data
duration, 327
latency, 327
questions, in communication and social skills, 325–326, 325t
summarization, in Skills Checklist, 90–93, 91f, 92f, 93f
time sampling, 327
Data collection
Assessment of Social and Communication Skills for Individuals with Autism Spectrum Disorder, Revised (ASCS-2) guidelines
direct sampling of skills, 78–79, 116
interviews, 77, 102, 108, 116
observations, 78, 102, 108, 116
structured communication opportunities, 79
structured social opportunities, 79
forms
qualitative data, 339–355
quantitative data, 328–339
for intervention decisions
collecting data, 355, 364

338
 data review, 364
see also Qualitative data collection; Quantitative data collection
Deferred imitation, 31
Delayed echolalia, 52
Developmental interventions, 194, 197, 202–203
Developmental milestones, 24, 24t, 42
prelinguistic stage, 25
preverbal communication phase, 25–26
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), 3
autism spectrum disorder criteria, 5–6, 5f, 8
Direct sampling techniques, for social and communication skills assessment, 78–79, 116
Directive interaction style, 228–229, 228t
in dance of interaction, 230–232
facilitative style combination with, 230–232
Discrete trial training (DTT), 194
Lovaas UCLA Model of ABA, 201
Discussion, 173, 174t
Distributors of education materials, 196
DO-WATCH-LISTEN-SAY framework
communication skills in, 62
social play in, 168–169
for social skills, 62, 159–162, 161f
intervention, 155–159, 161f
skill progression, 161–162, 161f
task analysis, 159, 160f
DSM-5, see Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
Duration data, 327
Dyspraxia, 7

EBPs, see Evidence-based practices

Echolalia, 6, 53
delayed, 52
immediate, 52
mitigated, 52
Ecological inventories, as qualitative data collection method, 327
Educational assessments
formal and informal types, 66
IEPs and, 66, 232
purposes of, 66
Educational history, of autism spectrum disorder (ASD)
applied behavior analysis (ABA), 4
free and appropriate public education (FAPE), 4
Individuals with Disabilities Education Act (IDEA), 4, 8, 323
least restrictive environment (LRE), 4
Emerging evidence-based practices (EBPs), 193, 195–196
Emerging skill, 324, 328
Emotional deprivation theory, 2–3, 11–12
Empathizing, 20
Environmental cues
contrived, 220
natural, 220
Evidence-based practices (EBPs), 5, 193, 195
categories
behavioral intervention, 194, 197, 201–202
developmental intervention, 194, 197, 202–203
naturalistic intervention, 194, 197, 203–205, 203f
emerging, 193, 195–196
established, 193, 195
resources for
Association for Science in Autism Treatment (ASAT), 196
Autism Internet Modules (AIM), 196
Institute of Education Sciences’ What Works Clearinghouse, 196
National Autism Center (NAC), 196–197, 197t
National Center for Evidence-Based Practice on Communication Disorders, 196
National Professional Development Center (NPDC) on Autism Spectrum Disorder, 196, 197, 198t–200t
Ohio Center for Autism and Low Incidence (OCALI), 196
selection of, 194–195, 195f, 205–207
Executive dysfunction, 10
Executive functioning, 74
Behavior Rating Inventory of Executive Function (BRIEF), 69t
Explicit instruction and interactions, 219, 222–237
systematic use of cues, 220–221, 263, 274
Exploratory play, 35
Expressive language, 48
Eye gaze, 25, 26–27, 29, 30, 31, 41

Facilitative interaction style, 228t, 229

339
 in dance of interaction, 230–232
directive style combined with, 230–232
Floortime developmental relationship-based model, 4
Formal assessments, 66
Fragile X syndrome, 3
Free and appropriate public education (FAPE), 4
Functional communication
functions expansion, 182
interventions for expansion of, 180–183, 182f
mirroring same-age peers, 145, 149, 149f, 182
multiple settings target, 182–183
social partners consideration, 182
Functional play, 35

Generalization, 74
building of, 145, 149–150, 149f
communication forms, 348, 381–382
multiple skills forms, 335, 337–339, 374–375
skill, 325, 328
skill forms, 329, 332, 333, 370
strategies to facilitate, 276
Gestalt processing, 15
Gestures, 26, 27, 29, 30, 31
activity sheet for, 280
Goals and objectives
child social and communicative competence maximization, 145, 146–148, 149f
generalization building, 145, 149–150, 149f
mirroring skills of same-age peers, 145, 149, 149f, 182
skill mastery and, 150–151, 150f
spontaneity increase, 145, 149f, 150
Group activities, 43–44
activity sheets use
for attending increase, 295–296
for following directions, 299–300
for turn taking in, 297–298
child cognitive, language skills and, 174–175
as context for intervention, 172
determining factors for child ability to participate, 43
group skills intervention design
intervention approaches, 174–175
progress forms, 346, 380
what skills to teach, 172–173
influences on, 173f
organization of, 173–174
participation organization, 246t, 248
for social skills, 295–300
types of, 173, 174t

Historical overview, of autism spectrum disorder (ASD)

educational history, 4
medical history, 2–4
Hypersensitivities, 12

ICD-10, see International Classification of Diseases and Related Health Problems, Tenth Revision
IDEA, see Individuals with Disabilities Education Act
IEP, see Individualized education program
Imaginative creative play
object substitution, 35
role taking, 35
Imitation
activity sheets use for enhancement
of motor imitation increase, 282
of social awareness increase, 281
of verbal imitation increase, 283
activity sheets use for enhancement of, 281–283
autism deficits, 32–33, 41, 215
deferred, 31
intervention design for
building skills, 154
what skills to teach, 154–155
intervention setting and, 215
invisible acts, 31
of invisible acts, 32
mirroring skills of same-age peers, 145, 149, 149f, 182
motor, 32–33, 282, 341, 376
sensorimotor, 32
typical development of, 31–32

340
 verbal, 283, 343, 377
Immediate echolalia, 52
Individualized education program (IEP), 66, 232
Individuals with Disabilities Education Act (IDEA), 4, 8, 323
Informal assessments, 66
Information processing, 9t
assigning meaning to experiences, 15–16
concrete thinking and, 16–17
context blindness, 14–15
definition of, 13
gestalt processing, 15
learning and, 16–17
memory and, 18–19
visual thinking, 17–18
weak central coherence (WCC), 14
Institute of Education Sciences’ What Works Clearinghouse, 196
Instructional strategies to enhance social and communication skills, 209
explicit instruction and interactions, 219–237, 274
natural social reinforcement, 274
planned scaffolding, 274
systematic prompts, 274
teaching opportunities, 210–219
visually cued instruction, 251–259, 251t
Intelligence tests, 17
Intent of social–communicative interactions, 224–226
Interaction patterns modification, 232, 236
augmentative and alternative communication (AAC) supports use, 234
giving child time to respond, 235
joint attention establishment, 233
maintaining close proximity to child, 233
making nonverbal cues more explicit, 234, 274
rhythmic language use, 235
simplifying language complexity, 233–234
Interaction routines
directive, 228–229, 228t
directive and facilitative combinations, 230–232
facilitative style of, 228t, 229–230
Interactive communication boards, 262–263
Interdivisional Research Group, of Council for Exceptional Children (CEC), 196
International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), 5
Intervention design
communication intervention, 149
core skills intervention, 150–153, 152f, 159, 162
needs prioritization, 142, 143t, 144–145
overview, 142–145, 143f, 143t
performance levels assessment, 142, 143t, 144–145
progress measurement, 143t
social intervention, 149
steps in, 141–142, 142f
target goals and objectives for, 143t, 144, 146t
child social and communicative competence maximization, 145, 146–148, 149f
generalization building, 145, 149–150, 149f
mirroring skills of same-age peers, 145, 149, 149f, 182
skill mastery and, 150–151, 150f
spontaneity increase, 145, 149f, 150
see also Progress monitoring
Intervention setting, anxiety and, 190, 214
Interviews, for assessment of social and communication skills, 77, 102, 108, 116
Invisible acts, imitation of, 31

Joint attention, 10, 26–27, 30–31, 41, 48, 49, 233

activity sheet for, 279

Language, 6
communication skills compared with, 50–51
definition of, 47
expressive, 48
peer interactions, 42, 235–237
rhythmic language use, 235
rules of, 47, 47t
sign, 261–262
simplifying complexity of, 233–234
social context, 47
theory of mind (ToM) deficit and, 57
Language skills
communication skills compared to, 50–51
group activities and child cognitive, 174–175

341
Latency data, 327
Learning, 12, 16–17
structured opportunities for, 152
see also Social skills
Least restrictive environment (LRE), in education, 4
Leisure activities, see Play

Making Action Plans (MAPS), 144

Manipulative play, 35
Meaning in experiences, 15–16
Meaningful activities, 218–219
Medical diagnosis, of autism spectrum disorder (ASD), 5–6, 5f
Medical history, of autism spectrum disorder (ASD), 2–4
Memory, 18–19
Mirroring skills of same-age peers, 145, 149, 149f, 182
Mitigated echolalia, 52
Modeling video, 255–257
Monitoring progress, see Progress monitoring
Mood disorders, autism spectrum disorder (ASD) coexisting with, 7
Motivating activities, 217–218
Motor imitation, 32–33, 282, 341, 376
Multiple skills
generalization forms, 335, 337, 338, 339, 374–375
mastery forms, 333–335, 336, 371–372
social and communication rating scales, 384, 385

Narratives, as qualitative data collection method, 327

National Autism Center (NAC), 196–197, 197t
National Center for Evidence-Based Practice in Communication Disorders, 196
National Professional Development Center (NPDC), 196, 197, 198t–200t
National Standards Project (NSP), 196–197
Natural samples, as qualitative data collection method, 327
Naturalistic interventions, 197
contemporary approach, 203–205, 203f
Pivotal Response Training (PRT), 194
Nature of autism, 2–4
Needs prioritization, in intervention design, 142, 143t, 144–145
Nonverbal social–communicative interaction, 6, 62
autism deficits, 6, 27–31, 28t
behavioral regulation, 26, 29
conversational discourse and, 320–321
joint attention, 26–27, 30–31
reciprocal interaction, 26, 29–30, 39
social play, 39
social skills prompts, 221–222
typical development of, 24–26, 27
understanding intent, 224–226
NSP, see National Standards Project

Object substitution, 36
Observations, for assessment of social and communication skills, 78, 102, 108, 116
Obstacles Questionnaire, in Assessment of Social and Communication Skills for Individuals with Autism Spectrum Disorder, Revised (ASCS-2), 71,
75, 80–84, 82t, 83f, 84f, 85f, 86f, 108–115
Ohio Center for Autism and Low Incidence (OCALI), 196
Open-ended activities, 216–217
play, 163, 166t
Organization skills
activity organization, 223–237, 249–250, 275
activity sheets use for enhancement
of material organization increase, 284
of organization choices increase, 285
of time organization increase, 286
intervention setting and, 215
organized versus disorganized child characteristics, 241–242, 241t
Organizational supports
activity routines organization, 249–250, 275
physical and social environments contrast, 240t
physical environment organization, 241
boundaries established and areas labeled, 242
community participation, 247t, 249
group participation, 246t, 248
rules, procedures and routines established, 242–243
social play, 244t, 248
for social skills support, 243–249
solitary play, 243, 244t
visual schedules, 249–250
Organized interactions, 223

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 establishing reciprocal social routines, 225–229
interaction patterns modification, 232–235
peer interactions coaching, 235–237
understanding communicative intent, 224–226
Overselective attention, 11–12

Parallel play, 38, 38f, 39

PECS, see Picture Exchange Communication System
Peer interactions
acting as interpreter for facilitation of
coaching peers, 235–237
shadowing child with autism, 236
developmental patterns in autism, 42
see also Social skills
Perseverative play, 36
Perspective-taking
in conversation, 55–56
in social skills, 301–303
Physical environment
intervention setting, 214–216
organization of, 241
boundaries established and areas labeled, 242
community participation, 247t, 249
group participation, 246t, 248
rules, procedures and routines established, 242–243
social play, 244t, 248
for social skills support, 243–249
solitary play, 243, 244t
social environment compared with, 240t
Picture Exchange Communication System (PECS), 180, 260–261
Pivotal Response Training (PRT), 194
Planning, see Intervention design
Play
associative, 38, 38f, 39
closed-ended, 43, 163, 166t
cooperative, 38, 38f, 39, 40
creative, 34
imaginative, 35, 36
with objects, 35, 36, 42
with self, 35
symbolic, 35–36
functional, 35
increase attention and independence, 163
object substitution, 35
open-ended, 163, 166t
parallel, 38, 38f, 39
perseverative, 36
play script, 35–36
ritualized, 36, 42
role taking in, 35
symbolic
in autism spectrum disorder (ASD), 36–37
creative, 35–36
routine symbolic play script, 35–36
in typical development, 34–36, 34f
typical development of play behaviors, 34–40, 37f
unstructured, 173, 174t
see also Social play; Solitary play
Pragmatic skills assessment, 69, 72t
Prelinguistic stage, of developmental process, 25
Prevalence, of autism spectrum disorder (ASD), 4–5
Preverbal communication, 25
in autism spectrum disorder (ASD), 49–50
typical development, 48–49
Prognosis, of autism spectrum disorder (ASD), 5
Progress forms
communication skills, 342, 343, 347, 349, 365
core skills, 339, 342
group skills, 346, 380
motor imitation, 341, 376
social play, 345, 379
social skills, 342
solitary play, 344, 378
verbal imitation, 343, 377
Progress monitoring, using Assessment of Social and Communication Skills for Individuals with Autism Spectrum Disorder, Revised (ASCS-2), 131–
136, 323, 356–365
data collection forms, 328–355

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 social and communication skill development
data question, 325–326, 325t
objectives specification, 324
qualitative measures, 325, 326t, 327
quantitative measures, 325, 326–327, 326t
skill criteria defined, 324
Prompts
for communication, 221–223
definition of, 221
for nonverbal social skills, 221–222
selection factors, 221–222
systematic, 274
types of, 221
visual cues as, 222
Prosocial behaviors (skills), 39
PRT, see Pivotal Response Training

Qualitative data collection, 324, 325, 325t, 326, 326t, 327, 328
audio and video recording, 78, 79, 327
ecological inventories, 327
forms
communication generalization, 348, 381–382
community planning guide, 352, 356–363, 384, 387–390
conversation transcript, 350, 382
narratives, 327
natural samples, 327
rating scales, 327
communication skills, 354, 386
multiple social and communication skills, 385
social and communication skills, 347, 352
social skills, 384
Qualitative data progress forms
communication skills, 342, 343, 347, 349, 365
core skills, 339, 342
group skills, 346, 380
motor imitation, 341, 376
social play, 345, 379
social skills, 342
solitary play, 344, 378
verbal imitation, 343, 377
Quantitative data collection, 326t
duration data, 327
forms
emerging skills, 328, 330, 368
multiple skills generalization, 335, 337, 338, 339, 374–375
multiple skills mastery, 333–335, 336, 371–372
skill generalization, 329, 332, 333, 370
skill mastery, 329, 331, 369
Social Task Analysis, 335, 339, 340, 375
frequency data, 326
latency data, 326
time sampling data, 327
Questions
answering increase, from activity sheet, 308–309
asking increase, from activity sheet, 312
data, in social and communication skill development, 325–326, 325t

Rating scales
communication skills, 354f, 386
multiple social and communication skills, 384, 385
as qualitative data collection method, 327
social and communication skills, 347, 348, 352
social skills, 351–352
Reciprocal interactions
for autism spectrum disorder (ASD), 28, 29–30, 39
communication and, 39, 49
nonverbal social-communicative, 26, 29–30, 39
social play and, 39
strategies for, 274
typical development of, 24–26, 27
verbal reciprocity increase, 316–317
Reciprocal social routines
basic, 226
directive and facilitative styles, 228–229
scaffolding, 227–228
Recognition abilities, 18
Reinforcing behaviors, 223

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Relaxation cues, 258
Repetitive activities, 11–13, 218
desire for sameness, 59
focused interests, 58–59
reasons for, 60–62, 267
rituals, 59–60
sensory environmental input reaction, 60
stereotyped behavior, 58
see also Ritualistic behaviors
Repetitive behaviors intervention, 188, 268, 272
anxiety, 190, 214
assessment of, 189, 267
impaired sensory regulation, 190
impaired social cognition, 190–191
key features of, 269–270, 269t
plan sources, 269f
poor inhibition, 190
support strategies, 270–271
underlying causes determination, 189–190
Repetitive play acts, 36–37
Requesting skills, 304–305
Research-based rationale, for evidence-based practices (EBPs), 196
Restricted behavior in autism, 58–61, 74, 83f, 141, 188–191, 214, 218, 224, 266
Resources
Association for Science in Autism Treatment (ASAT), 196
Autism Internet Modules (AIM), 196
Institute of Education Sciences’ What Works Clearinghouse, 196
National Autism Center (NAC), 196–197, 197t
National Center for Evidence-Based Practice on Communication Disorders, 196
National Professional Development Center (NPDC) on Autism Spectrum Disorder, 196, 197, 198t–200t
Ohio Center for Autism and Low Incidence (OCALI), 196
Rhythmic language, 235
Ritualistic behaviors, 5, 59, 59t
assessing function of, 61
overselective attention and, 11–12
in play, 36, 42
self-stimulatory, 12, 36, 58
theories regarding origin of, 60–61
verbal rituals, 58, 189
Role taking, 35
Rote memory, 18

Scaffolding
planned, 274
for reciprocal social routines, 227–228
systematic scaffold skills, 152–153
Screening and diagnostic instruments, 67, 68t
Seizures, 4, 7
Self-regulation skills
emotional regulation activity sheet, 288
successful transitions activity sheet, 287
visuals for, 257–258
Self-stimulatory ritualistic behaviors, 12, 36, 58
Sensorimotor imitation, 32
Sensory sensitivities, 45–46, 60, 190
intervention setting and, 214
motivating activities and, 218
solitary play and, 162–163
Separation anxiety, 45
SETT, see Student, Environments, Tasks, Tools framework
SGD, see Speech-generating device
Shared attention, 215
Shifting attention, 13–14, 41
Sign language, 261–262
Situations-Options-Choices-Consequence-Strategies-Simulation (SOCCSS), 253, 259
Skill mastery, 324, 328
forms for, 329, 331, 369
multiple, forms for, 333–335, 336, 371–372
target goal and objectives of, 150–151, 150f
Skills Checklist, in Assessment of Social and Communication Skills for Individuals with Autism Spectrum Disorder, Revised (ASCS-2), 71–72, 76–77,
84, 86–89, 87t, 88f, 89f
assessment, 118–129
data summarization, 90–93, 91f, 92f, 93f
overview, 116–117
progress monitoring display, 131–136
Social assessments, 67, 70t
Social attention, 5, 10–11

345
Social autopsies, 253
Social cognition, 9t, 10–11
empathizing and systemizing, 20
impaired, 190–191
social misunderstanding, 20–22, 21f
theory of mind (ToM) deficit and, 19–20, 21f
Social competence, 33f
Social context for intervention, 211–214, 211t, 212f
Social cues, 20, 45–46
contrived, 220
natural, 220
Social decision-making strategies, 258–259
Social encyclopedia, 252
Social functions of communication, 19, 175
Social interaction, 25
imitation and, 31
social play, 39
Social misunderstanding, 20–22, 21f
Social motivation, 75, 108
intervention setting and, 215
motivating activities, 217–218
Social narratives, 255
Social orienting, 10
Social perspective-taking skills, for friendship skills increase, 303
Social play
activity sheets for increase of, 291–294
of children with autism, 40–43, 42t, 171
cores skills abilities and, 171
critical elements of, 38–39, 38f
dimensions of, 169t
in DO-WATCH-LISTEN-SAY framework, 168–169
nonverbal social–communicative interaction in, 39
organization of, 244t, 248
progress forms, 345, 379
prosocial behavior, 39
reciprocal communication, 39
social interaction, 39
social partners skills, 170, 170t
typical development, 37–40, 37f
Social reinforcers, 274
Social routines, 227
Social scripts, 254–255
Social settings, 214–215, 214f
Social skills
activity sheets, 289–303
for social play, 291–294
for solitary play, 289–290
child social competence maximization, 33f
community skills
assessment, 186–187
intervention planning framework, 187t
support plan, 188
targeting skills, 187–188
core skills for, 25, 159, 160f
data questions, 325–326, 325t
development of, 33–45, 159–162
autism deficits, 41–42
milestones for, 40–41, 40t
DO-WATCH-LISTEN-SAY framework for, 62, 160
skill progression, 161–162, 161f
task analysis, 159, 160f
group activities, 295–300
perspective-taking in, 301–303
progress forms, 342
rating scales, 351–352
ritualistic behaviors and, 58, 59t
see also Assessment of social and communication skills
Social skills intervention
core skills abilities and, 159, 162
DO-WATCH-LISTEN-SAY framework for, 155–159, 161f
planning, 144–145
social partners and, 162
Social supports
acting as interpreter to facilitate peer interactions
coaching peers, 235–237
shadowing child with autism, 236
augmentative and alternative communication (AAC) supports, 178–179, 179t, 180t, 234, 259–266, 260t

346
 balancing direction and facilitative interaction styles
combining styles, 228–229
dance of interaction, 230–232
establishing reciprocal social routines, 225
basic social routines, 226
directive and facilitative styles, 228–229
scaffolding, 227–228
visual supports, 251–259
see also Interaction patterns modification
Social Task Analysis, 335, 339, 340, 375
Social understanding, 224–226
Sociobehavioral displays, 257
Socioemotional communication skills
activity sheets use
for basic feelings expression, 313
for complex feelings expression increase, 314
for prosocial statements, 315
Socioemotional relationships, 44–45
Software, educational, 265
Solitary play, 11, 37, 38, 41
activity sheets for increase of, 289–290
building on interests and sensory preferences, 162–163
closed-ended, 166t
expanding existing play, 163, 164t–165t
independence in, 163
intervention design for
interventions approaches, 163–166
what skills to teach, 162–163
open-ended, 166t
organization of, 243, 244t
Speech, 47
Speech-generating device (SGD), 178, 264–265
Spontaneity
in communication, 231
enhancement of, 275
Strategies to enhance social and communication skills
augmentative and alternative communication (AAC) supports, 178–179, 179t, 180t, 234, 259–266, 260t
best practices debate and
discrete trial training (DTT), 194, 201
compensatory strategies, 275t
evidence-based practice (EBPs), 5, 193–207, 195f, 197t, 198t–200t
organizational supports, 241–249, 244t, 246t, 247t
see also Teaching opportunities
Structured communication opportunities, 79
Structured nonverbal turn-taking, 173, 174t
Structured social opportunities, for assessment of social and communication skills, 79
Structured teaching, 242
Structured verbal turn-taking, 173, 174t
Student, Environments, Tasks, Tools (SETT) framework, 179
Symbolic play
in autism spectrum disorder (ASD), 36–37
creative, 35–36
routine symbolic play script, 35–36
in typical development, 34, 34f, 36
exploratory or manipulative, 35
functional, 35
imaginative or pretend, 35
Systemizing, 20

Teaching opportunities
adaptations, 210–211
closed- or open-ended activities, 216–217
environmental arrangement, 217–219
setting arrangement, 214–216
social context selection, 211–214, 211t, 212f
environmental arrangement activities selection, 216–219
meaningful activities, 218–219
motivating activities, 217–218
Universal Design for Learning (UDL), 210
Theory of mind (ToM), 19–20, 21f
conversational skills and, 57
Time sampling data, 327
Topic maintenance, in conversation, 55
Turn-taking, 29, 55
in group activities, 297–298
structured nonverbal, 173, 174t
structured verbal, 173, 174t

347
Typical development
of communication skills, 48–49, 53–56
of conversation, 54–56
of imitation, 31–32
of nonverbal social–communicative interaction, 24–26, 27
of play behaviors, 34–40, 37f
of preverbal communication, 48–49
of reciprocal interactions, 24–26, 27
of social play, 37–40, 37f
of symbolic play, 34, 34f, 36
exploratory or manipulative, 35
functional, 35
imaginative or pretend, 35
of verbal communication, 51–52
components of, 51f
first words, 50
sentences, 50
word combinations, 50

Unison activity, 173, 174t

Universal Design for Learning (UDL), 210
Unstructured play, 171, 173, 174, 174t

Verbal communication
activity sheets for enhancement of, 283, 316–319
autism deficits, 51–53
typical development, 51
components of, 51f
first words, 50
sentences, 50
word combinations, 50
understanding intent, 224–226
see also Preverbal communication
Verbal conversation, 57, 316–319
Verbal imitation, 283, 343, 377
Verbal rituals, 58, 189
Video modeling, 255–257
Videotaped analysis, for assessment of social and communication skills, 78, 79, 327
Vineland Adaptive Behavior Scales, 69t
Visual imagery, 252, 257–258
Visual schedules, 249–250
Visual thinking, 17–18
Visually cued instruction, 222
benefit of, 251t, 253
definition of, 251
rationale for, 251, 251t
types of
activity schedules, 240, 253, 254
cue cards, 254
relaxation cues, 258
self-regulation visuals, 257–258
social decision-making strategies, 258–259
social encyclopedia, 252
social narratives, 255
social scripts, 254–255
sociobehavioral displays, 257
video modeling, 255–257
visual imagery, 252, 257–258
uses of, 251t, 252–253
Voice output communication aids (VOCA), 177t, 178, 264–265

Weak central coherence (WCC), 14

Words
combinations, 50
first, 50
sentences, 50
World Health Organization (WHO), International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), 5

348